
Class __S,X:i^\_- 

Book, jC 1 

CopightN" 



COPYRIGHT DEPOSIT. 



THE LIBRARY 



OF 



HOME ECONOMICS 



A COMPLETE HOME-STUDY COURSE 

ON THE NEW PROFESSION OF HOME-MAKING AND ART OF RIGHT LIVING; 

THE PRACTICAL APPLICATION OF THE MOST RECENT ADVANCES 

IN THE ARTS AND SCIENCES TO HOME AND HEALTH 

PREPARED BY TEACHERS OF 
RECOGNIZED AUTHORITY 

FOR HOME MAKERS, MOTHERS, TEACHERS, PHYSICIANS, NURSES, DIETITIANS, 

PROFESSIONAL HOUSE MANAGERS, AND ALL INTERESTED 

IN HOME, HEALTH, ECONOMY AND CHILDREN 



TWELVE VOLUMES 

NEARLY THREE THOUSAND PAGES, ONE THOUSAND ILLUSTRATIONS 

TESTED BY USE IN CORRESPONDENCE INSTRUCTION 

REVISED AND SUPPLEMENTED 




CHICAGO 

AMERICAN SCHOOL OF HOME ECONOMICS 

1907 



LIBRARY of CONGRESS 
OneOoov deceived 

AP« 26 I5J0/ 

9M|.»f»*nt Entry 



Copyright, 1907 

BY 

Home Economics Association 



Entered at Stationers' Hall, London 
All Rights Reserved. 



AUTHORS 



ISABEL BEVIER, Ph. M. 

Professor of Household Science. University of Illinois. Author U. S. 
Government Bulletins, "Development of ' the Home Economics 
Movement in America," etc. 

ALICE PELOUBET NORTON, M. A. 

Assistant Professor of Home Economics, School of Education, Uni- 
versity of Chicago ; Director of the Chautauqua School of Domestic 
Science. 

S. MARIA ELLIOTT 

Instructor in Home Economics, Simmons College; Formerly Instruc- 
tor School of Housekeeping, Boston. 

ANNA BARROWS 

Director Chautauqua School of Cookery ; Lecturer Teachers' College, 
Columbia University, and Simmons College ; formerly Editor "Ameri- 
can Kitchen Magazine;" Author " Home Science Cook Book." 

ALFRED CLEVELAND COTTON, A. M., M. D. 

Professor Diseases of Children, Rush Medical College. University of 
Chicago; Visiting Physician Presbyterian Hospital, Chicago ; Author 
of " Diseases o,f Children." 

BERTHA M. TERRILL, A. B. 

Professor in Home Economics in Hartford School of Pedagogy; 
Author of U. S. Government Bulletins. 

KATE HEINTZ WATSON 

Formerly Instructor in Domestic Economy, Lewis Institute; Lecturer 
University of Chicago. 

MARION FOSTER WASHBURNE 

Editor "The Mothers' Magazine;" Lecturer Chicago Froebel Asso- 
ciation; Author " Everyday Essays," "Family Secrets," etc. 

MARGARET E. DODD 

Graduate Massachusetts Institute of Technology ; Teacher of Science, 
Woodward Institute. 

AMY ELIZABETH POPE 

With the Panama Canal Commission ; Formerly Instructor in Practical 
and Theoretical Nursing, Training School for Nurses, Presbyterian 
Hospital, New York City. 

MAURICE LE BOSQUET, S. B. 

Director American School of Home Economics ; Member American 
Public Health Association and American Chemical Socie'ty. 



CONTRIBUTORS AND EDITORS 



ELLEN H. RICHARDS 

Author " Cost of Food," " Cost of Living," " Cost of Shelter," " Food 
Materials and Their Adulteration," etc., etc.; Chairman Lake Placid 
Conference on Home Economics. 

MARY HINMAN ABEL 

Author of U. S. Government Bulletins, "Practical Sanitary and Econ- 
omic Cooking," " Safe Food," etc. 

THOMAS D. WOOD, M. D. 

Professor of Physical Education, Columbia University. 

H. M. LUFKIN, M. D. 

Professor of Physical Diagnosis and Clinical Medicine, University of 
Minnesota. 

OTTO FOLIN, Ph. D. 

Special Investigator, McLean Hospital, Waverly, Mass. 

T. MITCHELL PRUDDEN, M. D., LL. D. 

Author "Dust and Its Dangers " "The Story of the Bacteria," "Drink- 
ing Water and Ice Supplies," etc. 

FRANK CHOUTEAU BROWN 

Architect, Boston, Mass.; Author of "The Five Orders of Architec- 
ture," " Letters and Lettering." 

MRS. MELVIL DEWEY 

Secretary Lake Placid Conference on Home Economics. 

HELEN LOUISE JOHNSON 

Professor of Home Economics, James Millikan University, Decatur. 

FRANK W. ALLIN, M. D. 

Instructor Rush Medical College, University of Chicago. 



MANAGING EDITOR 

MAURICE LE BOSQUET, S. B. 

Director American School of Home Economics. 



BOARD OF TRUSTEES 

OF THE AMERICAN SCHOOL OF HOME ECONOMICS 



MRS. ARTHUR COURTENAY NEVILLE 

President of the Board. 

MISS MARIA PARLOA 

Founder of the first Cooking School in Boston; Author of "Home 
Economics," " Young Housekeeper," U. S. Government Bulletins, etc. 

MRS. MARY HINMAN ABEL 

Co-worker in the " New England Kitchen," and the "Rumford Food 
Laboratory;" Author of U. S. Government Bulletins, " Practical 
Sanitary and Economic Cooking," etc. 

MISS ALICE RAVENHILL 

Special Commissioner sent by the British Government to report on the 
Schools of Home Economics in the United States; Fellow of the 
Royal Sanitary Institute, London. 

MRS. ELLEN M. HENROTIN 

Honorary President General Federation of Woman's Clubs. 

MRS. FREDERIC W. SCHOFF 

President National Congress of Mothers. 

MRS. LINDA HULL EARNED 

Past President National Household Economics Association ; Author 
of " Hostess of To-day." 

MRS. WALTER McNAB MILLER 

Chairman of the Pure Food Committee of the General Federation of 
Woman's Clubs. 

MRS. J. A. KIMBERLY 

Vice President of National Household Economics Association. 



MRS. JOHN HOODLESS 



Government Superintendent of Domestic Science for the province of 
Ontario; Founder Ontario Normal School of Domestic Science, now 
the MacDonald Institute. 





COPYRIGHT, 1903, BY LA ROCHE, SEATTLE 

AN INDIAN BABY 
Takima Papoose 



Care of Children 



BY 

ALFRED CLEVELAND COTTON, A. M., M. D. 

PROFESSOR DISEASES OF CHILDREN 

RUSH MEDICAL COLLEGE, UNIVERSITY OF CHICAGO 

ATTENDING PHYSICIAN DISEASES OF CHILDREN 

PRESBYTERIAN HOSPITAL 




CHICAGO 

AMERICAN SCHOOL OF HOME ECONOMICS 

1907 



^^' 



o\ 



c-^ 



COPYRIGHT, 1906, BY 
HOME ECONOMICS ASSOCIATION 

Entered at Stationers Hall, London 
AH Rights Reserved 



CONTENTS 



Letter to Students 

Hygiene of the Baby 

New Born Baby 

Care of the New Baby 

Baby's Clothes 

Clothing for Older Children 

Surroundings and Care . 

Sleep .... 

Exercise .... 

Bathing 

Regulation .... 

Development and Growth 

Teething .... 

Development of Special Senses 

Nutrition of the Child . 

Natural Food 

Weaning and Substitute Feeding 

Artificial Feeding 

Modified Milk 

Foods Other Than Milk 

Food Disorders 

Food after the First Year 

Food Recipes .... 

The Sick Child 

The Cry .... 

Colic .... 

Constipation . ' . 

Summer Diarrheas . . 

Apnormal Passages 

Rickets, Malnutrition, Scurvy 

Colds .... 



V 

I 
6 

IS 
20 

30 
32 
34 
37 
38 
39 
42 

47 
50 
55 
56 

71 
76 
90 
109 
113 
115 
119 
123 

125 
127 
128 
130 

134 
136 
141 



lU 



CONTENTS 



Sore Throat 


142 


Croup ....... 


• 145 


Temperature . . . . . 


147 


Nervous Disorders . . 


. 148 


Convulsions, Spasms, Fits, Cramps 


149 


Contagious Diseases .... 


• 153 


Measles ...... 


154 


Scarlet Fever . . . . • . 


.155 


Chicken pox . . , . . 


. 156 


Diphtheria . . . . . . 


• 157 


Whooping Cough . . . • . 


. 158 


Foreign Bodies ..... 


• 159 


P^arache ...... 


160 


The Medicine Chest 


. 163 


Hygiene of the Child and Youth 


. 165 


Education ...... 


. . 167 


Pubescence ..... 


171 


Bibliography ...... 


. 174 


Sodium Citrate in Infant Feeding 


179 


The Soother ...... 


. 192 


Program for Supplemental Study 


201 


Index ....... 


. 205 



AMERICAN SCHOOL OF HOME ECONOMICS 
CHICAGO 

January 1» 1907. 
My dear Madara: 

In my private practice I meet 
so many mothers, well educaxed otherwise, who 
are profoundly ignorant of the care of children 
that it is a pleasure to find one who is willing 
to study something of the subject in a systemat- 
ic way. 

The feeding of children, especially of 
bottle babies, calls for the utmost skill of the 
trained physician, while the responsibility of 
a sick child is too great for any mother or 
nurse. 

It goes without saying that a subject 
which oft tines taxes the knowledge of exper- 
ienced physicians cannot be mastered in a few 
short lessons by the average mother. It is only 
in the hope that some of the fundamental prin- 
ciples embodied herein may be impressed upon the 
student mother's mind and lead to a better appre- 
ciation of the importance of details in the man- 
agement of the child that these lessons are of- 
fered. 

Children are not alike, nor can they be 
classified according to their peculiarities 
with a view to successful care or treatment of 
their varying disorders. Each child has his 
particular individuality, study and appreciation 
of which marks the highest type of the success- 
ful physician. The name of the disease or dis- 
order is usually of less importance than the in- 
dividuality or peculiarity of the child. 

The dosing of children according to any 
stereotyped formula for real or imaginary ail- 



ments cannot be too vigorously condemned and 
the wise mother will rarely administer medi- 
cines except under the advice of the physician. 

Prevention is alvrays much easier than cure 
and a mother's greatest opportunity comes in 
so caring for her child that he may seldom re- 
quire the services of the physician. 

I regret that I shall not be able to give 
the time to look over your answers personally, 
but my assistant will call upon me freely and 
I shall be glad to give any personal assistance 
that I can. 

Very truly yours, 





ONE OF DR. COTTON'S BABIES IN THE "BABY BAG. 



CARE OF CHILDREN 

Hygficne of the Baby 



T^ HE care of the infant should begin from the 
moment of conception. So much does the 
normal development of the unborn child depend 
upon the physical vigor and mental balance of the 
mother that her health during pregnancy is of the 
highest importance. Everything that tends to im- 
prove the mental and physical condition, such as 
wholesome food, pleasant surroundings, congenial 
associates, exercise, fresh air and sunshine should 
be secured for the expectant mother. 

Under favorable hygiene even the very delicate 
woman may bear and nourish healthy children. 

During pregnancy, especially in the advanced 
stage, laborious occupation and violent exercise 
must be avoided. The exercise involved in walking 
and in the duties of light housework is beneficial 
while the exertion incident to laundry work, pro- 
longed use of the sewing machine, hill climbing 
and driving over rough roads may be positively 
injurious or even dangerous. 

Corsets should be discarded upon the first evi- 
dence of conception and loose clothing suspended 
from the shoulders should be adopted, thus reliev- 
ing the hips and abdomen of all weight and com- 
pression. The ideal dress for this period is the union 



Care of 
the Baby 
Before 
Birtli 



Jare of 
the Mother 



Dress 



CARE OF CHILDREN 




A PRINCESS MATERNITY GOWN 

Ladies' Home Journal Pattern. 



BEFORE THE BABY COMES 



suit, a light petticoat fastened to a loose waist and 
an empire gown. In cold weather vv^ool tights may 
be worn instead of additional skirts. 

The process of making blood and tissue for the 
unborn as well as for the mother makes heavy de- 
mands upon her vital energy, hence not only in- 
creased nourishment is necessary but extra sleep, 
so that a daily nap should be secured unless it inter- 
feres with the sleep at night. A liberal supply of 
substantial but easily digested food should be pro- 
vided and the appetite, if sluggish, stimulated by 
outdoor exercise and tempting dishes. Fresh fruits 
and vegetables in season should form part of the 
dietary in the absence of which canned vegetables 
and stewed fruits may be substituted. A heavy diet 
of meats and rich foods which overtax the digestion 
should be avoided. 

The tendency to constipation at this time may 
usually be relieved by a generous supply of juicy 
fruits and the coarser cereals, such as oat meal, corn 
meal, graham, whole wheat and brown bread. 

The nausea and vomiting (morning sickness) so 
common during the first months of this interesting 
condition may occasionally be relieved by a cup of 
hot coffee or broth taken before rising. Dry mag- 
nesia \n\\ frequently relieve heart burn (sour stom- 
ach) and may act as a mild laxative. If constipation 
be obstinate a daily enema of from one to three 
pints of soapy water may be necessary. 



Food for 
the Mother 



Morningr 
Sickness 



CARE OF CHILDREN 



Gentle massage of the abdomen with oHve oil, 
cocoa butter or goose fat should be practiced daily, 
not only for its nutritious effect but to facilitate 
stretching of the tense skin. If the womb drags 
heavily upon the abdomen great relief may be ob- 
tained by a properly adjusted supporter so arranged 
as to support the lower part of the abdomen. 
The Breasts The breasts so essential to the future sustenance 

of the child, should be treated daily to the same 

gentle massage while the 
nipples should be gradu- 
ally toughened by the ap- 
plication of dilute alcohol 
or equal parts of brandy 
and water. If flat or de- 
AN ABDOMINAL SUPPORTER. P^esscd the uipplcs should 
From Griffith. j^g dcvelopcd by moulding 

with the fingers or drawing out with a cupping 
glass or breast pump. 

Swelled feet and distended veins of the legs may 
be due to pressure of the heavy womb and require 
frequent rest in the horizontal position with the 
feet elevated, while the limbs are gently stroked 
towards the body. In severe cases bandaging may 
be necessary which, however, should always be 
done under the advice of the physician. 
The TTrire A Specimen of the urine should be furnished the 

doctor from time to time for examination, especially 
during the later months of pregnancy, as dangerous 




BEFORE THE BABY COMES 



kidney complications may be thereby discovered 
and relieved by timely treatment. 

The teeth, which frequently soften and decay dur- 
ing pregnancy, should be put in first class condition 
by the dentist during the early months, thus pre- 
venting much suffering and maybe serious shock. 

The expectant mother should regard the coming 
of her baby with feelings of happy anticipation 
while dread of the ordeal should be kept sedulously 
.in the background. All means for promoting happi- 
ness and contentment should be cultivated as de- 
spondency, dread and discontent not only interfere 
with the mother's physical well-being but may tend 
to arrest or pervert development of the unborn 
child. 

The popular belief in birth marks as a result of 
disagreeable or unusual occurrences or sights is not 
well founded, but the hygiene of this period requires 
that the mother be protected from undue mental 
strain or intense emotional disturbances. 

All preparation for the advent of the little one 
should be simple, rational and complete long before 
the last weeks of pregnancy thereby avoiding the 
undue work and worry of hasty preparation. 

The pregnant woman should be under the care of 
a competent physician during the entire period of 
gestation. 

Since not only the life of the infant but his entire 



The Teeth 



Mental 
Conditions 



Preparations 



Importance 
of Early- 
Care 



6 CARE OF CHILDREN 

future health is dependent upon the nature of his 
early care, intelligent study of all that pertains to 
the hygiene of this little being is the highest duty 
of the young mother. The belief that instinct en- 
dows motherhood with knowledge requisite to her 
new responsibilities is not only erroneous but pro- 
ductive of great mischief, as the lost or ruined lives 
of thousands of mismanaged infants will attest. 
^"of°infant Viewed in this light a knowledge of the slightest 

Hygiene details of the infant's anatomy, physiology and 
hygiene assumes a new significance and may prove 
of inestimable value in conserving his health and 
insuring his normal development. The startling 
death rate in early infancy calls loudly for a more 
thorough study of the causes of poor development 
and disease most of which might be prevented by 
a better understanding of the infant and his re- 
quirements. It is evident that the simplest method 
of studying the new born infant is to become famil- 
iar with the details of his normal form and propor- 
tions, for in this way only may departures from the 
normal be recognized.. 

THE NEW BORN BABY 

Skin The infant's skin at birth is usually covered with 
a thick whitish substance (vernix caseosa) which 
is most abundant in the creases and depressions and 
upon the scalp. At birth the color is a dusky hue, 
which after a few full inspirations changes to the 




TWO NEW BORN BABIES 



THE NEW BORN BABY 9 

^'boiled lobster" red. About the third day a scahng 
of the skin begins, which continues for a week or 
ten days. The texture of the skin is very dehcate 
and is usually covered with a downy growth, called 
lanugo. 

The average weight at birth is about 7 pounds for 
boys and 6 pounds for girls. The average length 
is from 18 to 20 inches. 

To anyone seeing a new-born infant for the first 
time, the large head, small chest, enormous abdo- 
men and insignificant extremities seem out of all 
proportion. 

A constant proportional relationship exists be- 
tween the different members of the normal infant 
at birth. The following simple rule will aid the 
student in remembering this relationship. 

Rule. — Add 4 inches to half the baby's length for 
the chest circumference ; the head is one inch larger 
than the chest. The abdomen is ^ to 1 inch larger 
than the head, e. g. : 

Length „ „ 18 inches 

Circumference of thorax 13 inches 

Circumference of head 14 inches 

Circumference of abdomen 14% inches 

The head, being plastic, shows the pressure effects 
of recent birth. If labor has been prolonged it 
sometimes presents a great elongation and not in- 
frequently there is a soft doughy swelling as large 
as half an orange near the crown caused by the 



Weight 



Proportions 



The Head 



10 



CARE OF CHILDREN 



Fontanelles 



recent pressure. By the end of the first week the 
head should have resumed its normal shape. 

Adjacent margins of the bones of the head are 
separated by fibrous tissue continuous with the lin- 




I 



SKULL OF AN INFANT, SHOWING FONTANELLES. 



ing internally and the covering externally. At the 
places where three or more bones should come to- 
gether are soft spaces called fontanelles. The larg- 
est and most important of these is situated at the 
top of the head well to the front, and is often called 
the ''soft spot". In this space there is a regular 
pulsation corresponding in frequency with the heart 



THE NEW BORN BABY 



II 



beats. The fontanelles should be carefully guarded 
against injury. 

The softness and elasticity of the bones of infancy 
are due to their vascularity, the sponginess of their 
texture, and from the layers of cartilage and mem- 
brane not yet ossified. 

The true bony structure of the new born baby 
corresponds to the needs of the infant, e. g., the 
bones of the lower jaw and ribs and collar bone 
which renders possible respiration and suction from 
birth, are well developed. 

Over the cheek muscles, in addition to the ordi- 
nary layer of fat, there is an arrangement of fatty 
lobules on either side, called ''sucking cushions" 
because they prevent the cheeks being pressed in- 
ward between the jaws when nursing. 

The eye at birth is anatomically incomplete, 
which would prevent perfect sight even if the brain 
were ready to receive and interpret impressions. 
The color of the iris is a bluish gray and the pupils 
are large and sensitive to light. 

The lachrymal glands are not fully developed, 
hence no tears before the third month. 

The nose is relatively small, and the respiratory 
portion is very small. 

The tongue is rarely the seat of congenital defect 
and tongue tied babies are not often seen. 

The spine of the infant is extremely flexible. It 
is, in fact, almost wholly cartilaginous at birth, the 



Bones 



Sucking 
Cushions 



The Eyes 



The Spine 



12 



CARE OF CHILDREN 



The Lungs 



Blood 
Supply 



Respiration 



centers of ossification being present but the process 
only slightly advanced. 

The collar bone is the first bone of the skeleton 
to ossify and is more frequently fractured during 
delivery and in early childhood than is any other 
bone. 

Rapid and remarkable changes occur in the lungs 
after birth. During the first inspiration compara- 
tively little air is taken into the lungs but as one 
full inspiration follows another, inflation increases 
more and more until full distension is accomplished 
after which the lungs are never completely emptied 
of air during life. 

Growth and action of all the organs are entirely 
dependant on the blood supply. As the blood sup- 
ply not infrequently depends upon the muscular 
activity of the parts, it is plain that restrained 
activity or interference with circulation by any 
means retards both function and growth. In the 
care of the young infant too much stress can not 
be laid upon the importance of freedom of motion 
for all the members, and avoidance of anything that 
tends to compress the vessels, such as long con- 
tinued lying in one position, with possibly the addi- 
tion of blood stagnation in the dependent parts. In 
this respect, also, the clothing requires that no bands 
nor seams may press upon the vessels of ditribution 
or the return supply of blood. 

From birth to death the oxygen necessary for the 
vitality of the body is supplied through the air 



THE NEW BORN BABY 



13 



vesicles of the lungs. If any vital process is pre- 
eminent in its importance, it is that of respiration. 
Young children inhale more oxygen and exhale 
more carbon dioxide, relatively, than adults. This 
is a result of the more rapid tissue change in the 
growing organism. 

As respiration begins only after birth it is prob- 
ably the least developed of the vital functions. Its 
want of vigor is partly due to compressibility of 
the chest walls, to the lack of full development of 
the respiratory muscles and partly to the narrow- 
ness of the upper air passages. Care of the nose and 
throat is necessary to prevent accumulations or 
growths which interfere with the free entrance of 
air. 

The average rate of respiration is from 30 to 60 
per minute and during the early months may be very 
irregular. 

The yielding character of the chest renders the 
baby very susceptible to disturbances by compres- 
sion, so that great care should be exercised not only 
in the handling of the infant but also in the clothing 
so that no constriction of the chest be allowed. 

The glands of the mouth of the new born secrete 
mucus which serves for protection. The salivary 
secretion is established but feebly and possesses 
little, if any, power of changing starch to sugar. 

The stomach at birth secretes pepsin in very 
small quantity and at this early age is more of a 



Chest 



Digestive 
Organs 



14 CARE OF CHILDREN 

receptacle for food than a digestive organ. Coagu- 
lation of milk by the rennet ferment represents 
nearly the whole extent of its digestive function. 

Shortly after birth meconium (a viscid, tarry, 
odorless substance) is discharged from the bowels. 
This continues until the feces are changed to a 
canary yellow by the taking of milk. 

Urine is normally present in the bladder at birth 
and is usually voided within a short time, any delay 
beyond twelve hours causing some anxiety. The 
urine should be pale and odorless but it may con- 
tain uric acid crystals which stain the diaper like 
iron rust and are sometimes so abundant as to 
completely obstruct the small tubes of the kidneys. 
This uric acid is a frequent cause of colic in the 
new born. 
Care of The delicate skin of the infant demands constant 

the Skin 

care to prevent irritation and excoriations especially 
about the buttocks, from the urine and feces. It 
seems hardly necessary to remark that the diaper 
should always be removed as soon as it is wet or 
soiled and should never be used the second time 
without thorough washing. 
Nervous In rcs^ard to the functions of the nervous system 

System ^ 

it may be said that at birth the infant is merely a 
bundle of reflexes. Such reflex action however as 
respiration, swallowing, winking, coughing, sneez- 
ing, clinging, etc., shows a remarkable pre-natal 
development of mechanism. 



CARE OF THE NEW BABY 



15 



The sense of hearing is probably not present at 
birth, but is established within the first day or two, 
as the middle ear fills with air and the congestion 
of its mucous membrane subsides. 

In all probability smell is the last of the special 
senses to develop. 

The sense of taste is evidently well developed 
from birth, the young infant readily distinguishing 
milk from water. 

Tactile sensation is very acute in the lips, tongue 
and eyes, although feebly developed in other areas. 

CABE OF THE NEW BABY 

The newborn is entirely at the mercy of his sur- 
roundings. In fact, of all the mammalia, the human 
infant is the most helpless. 

Immediately upon delivery the baby should be 
wrapped in a warm soft shawl or blanket. The eyes, 
mouth and nose should be thoroughly cleansed of se- 
cretions by the gentle application of sterilized gauze or 
cheesecloth dipped in tepid . boric acid solution. A 
saturated solution of boric acid in boiling water, care- 
fully strained, cooled and bottled should be a part of 
the equipment of the confinement room and nursery; 
also a supply of sterilized gauze or cheesecloth cut in 
three-inch squares and kept in sterilized wrapping. To 
steriHze the cheesecloth or gauze it should be kept in 
boiling water for forty minutes, dried in an oven and 
at once wrapped in a sterilized cloth or wrapping. 



Special 
Senses 



First 
Cleansing 



i6 CARE OF CHILDREN 

Care of The eyes should be cleansed with separate pieces of 
gauze moistened with the boric solution by pouring 
from the bottle. If a few drops of the solution find 
their way between the lids so much the better. 

The mouth may be freed of mucus by wrapping the 
finger in dry steriHzed gauze and gently wiping out the 
secretion, after which the mouth should be washed 
with the boric acid solution. Then it is well to give the 
baby a teaspoonful or two of pure tepid water. 
Gentleness If necessary to free the nose from secretions it may 

be done by gently squeezing it between the thumb and 
finger from the top down, after which the solution 
should be applied on a piece of twisted gauze. Ex- 
treme gentleness must be observed in these manipula- 
tions so as to leave no wound or abrasion upon the 
delicate tissues which may give entrance to infective 
germs. The nurse's hands and nails should be cleansed 
beyond suspicion. 

Care of ^^^ *^^^^ ^^y ^^ freely dusted with pulverized boric 

the Cord ^^.j^j ^^^ covered with dry absorbent cotton. Placing 
the baby on the right side favors the new course of 
blood through the heart. 

The vernix caseosa with which the new born baby 
is usually covered is best removed by a thorough rub- 
bing with warm olive oil, or fresh lard, which forms 
with it a soft lather and is easily removed by gentle 
wiping with dry soft gauze. The next day's oiling and 
wiping will remove from the creases and folds what 



CARE OF THE NEW BABY 



17 



little of the substance may have escaped the first 
cleansing. 

On the question of the first bath there is a decided 
difiference of opinion. Considering- the temperature 
from which the new comer has emerged (100° F.), 
the transition to room temperature even, 78° F. 
would seem to be sufficiently stimulating. There is a 
growing opinion in favor of delaying the bath, and the 
writer believes with others that this first water bath 
should not be given for several days after birth. A 
daily rubbing with warm olive oil is to be preferred as 
affording less danger of shock. 

The baby's brief toilet completed, the dressed navel 
supported by a light flannel band, he should be 
wrapped in a fresh dry blanket and allowed to sleep 
in a warm, dark, quiet place for three hours, after 
which he may be given another drink of pure water. 

It is advisable to place the infant at the breast 
within a few hours after birth as it is believed that 
the colostrum or first milk secreted is adapted to the 
needs of the infant's digestive tract. The mother's 
nipples and the baby's mouth should be previously 
cleansed with boric acid solution. 

An infant's needs are few but imperative. They are 
warmth, food and repose. It should be disturbed only 
when necessary for drink, for its daily baths, change 
of clothing, or for fresh diapers. It should be nursed 
every two hours during the day and once at night. 



First 
Bath 



First 
Nursing 



Imperative 
Needs 



i8 CARE OF CHILDREN 

The child should not sleep with the mother or nurse, 
but in its own crib or basket from the first. 
Shock Too much stress cannot be laid upon the avoidance 

of all that tends to shock or fatigue, and the observance 
of absolutely antiseptic details. Could nurses and 
mothers realize the need of absolute rest for the new 
born, the advent of the baby would not be the signal 
for the ''rough house" procedures so frequently seen, 



General 
Water 




A RUBBER BATH TUB. 



in the bath attended by admiring relatives, the dressing 
in unsuitable garments, and the frequent exhibitions of 
the baby to delighted neighbors and caressing friends. 

First The first general water bath may be given to vigor- 

ous babies the fifth or sixth day, after which it may be 

■^^*^ . a part of the daily toilet. In cases of premature or 
very feeble infants the tub bath should be postponed 
until there is no danger from shock or chill. The early 



CARE OF THE NEW BABY 



19 




A Double Ewer for Hot and Cold Water. 



bathing should be done with the baby on the nurse's 
lap, protected from drafts by a soft blanket. Each 
part should be gently bathed with a cheese cloth 
sponge and quickly dried by patting with a dry, warm 
towel of the same material. New cheese cloth for 
this purpose may be 
rendered absorbent 
by thorough boiling 
in soda water, fol- 
lowed by careful 
rinsing. The animal 
sponges should not 
be used as they can- 
not be properly 
cleansed and quickly 

become breeding places for germs of many kinds. A 
full tub bath should not be given until the cord has 
come off. 

A good quality of castile soap is probably the best 
to use, for many of the so-called "baby soaps" are too 
irritating for the infant's delicate skin. After drying 
the creases may be lightly dusted with a reliable baby 
powder, using a box with a finely perforated top for 
this purpose. The ordinary puff ball and powder box. 
should not be used because they are so easily con- 
taminated with dust laden with bacteria. 

Unremittent care is required to prevent accumula- 
tions on the scalp. If crusts are once formed they must 
be softened by frequent applications of warm oil. 



Soap 



Care of 
the Scalp 



20 



CARE OF CHILDREN 



They should never be removed by use of the fine tooth 
comb, in fact a comb should not touch the baby's scalp 
during the early months and strong soap and friction 
must be avoided in the removal of the accumulations. 
Temperature The scnsitiveness of infants to heat and cold is 

not surprising v^hen- we consider the conditions, 
viz., the relatively large radiating surface of the 
body (50 per cent more than the adult), the thinness 
of the skin, the distensibility of its blood vessels, and 
the undeveloped state of the heat regulating centers. 
The normal body heat is highest in the afternoon 
and the lowest from 12 to 4 a. m. Rectal temper- 
ature, as a rule, is the only reliable one, as in the 
young infant the mouth can not be utilized for that 
purpose, and the surface of the body, for reasons 
above stated, shows a temperature two or three 
degrees lower than that of the blood. ' 

THE BABY'S CLOTHES 



Weight 

and 

Texture 



In the care of the baby uniformity of the sur- 
rounding temperature should be maintained and the 
child protected from excessive radiation by cloth- 
ing. Nothing is more appropriate for this purpose 
than wool and as lightness is desired two thick- 
nesses are better than one containing the same 
amount of material. Simply made clothing without 
elaborate ornamentation and trimming designed for 
the baby's comfort shows better taste in the mother. 



BABTS CLOTHES 21 

The clothing should not interfere with freedom of rreedom 
muscular movement or blood circulation. This means Restraint 
that it should permit unrestrained freedom of move- 




BABY CLOTHED IN A SLEEVELESS SACK OR "BABY BAG." 

ment of all the muscular structures, whether toes, 
fingers, feet, hands, legs, arms, abdomen, back or chest. 
The evils of the old fashioned pinning blanket, the 
tightly drawn diaper, as well as bands about the chest 



22 



CARE OF CHILDREN 



The 
Baby Bag 



and abdomen, and any tapes or strings, which re- 
strict the circulation should be apparent: 

Since the object of clothing for the infant is to se- 
cure uniform temperature the writer can conceive of 
no reason why one portion of the body requires heavier 
clothing than another, hence material of uniform thick- 
ness is required for trunk and limbs. 




OUTER AND IN^^ER GARMENT OF THE SLEEVELESS SACK. 

Inner garment shown closed at bottom with the draw string: onter 
garment opens. Both garments are fastened at the neck in front 
with safety pins. 

The ideal protection would seem to be afforded by a 
sack of light, flexible, nonconducting material, so con- 
structed that it envelops loosely the entire body, closed 



BABY'S CLOTHES 



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CARE OF CHILDREN 



Night 
Garment 



Under 
Jlothes 



above by safety pins, below by a draw string. Such an 
arrangement was designed by the author and has been 
successfully used in a number of hospitals in this coun- 
try and abroad as well as in private homes. There is 
good reason for including the hands in the covering 
as a prevention of the habit of putting the fingers in 
the mouth. This is a most unhygienic practice, first 
because it favors introduction of infections ; second, be- 
cause the subsequent chilling of the parts from rapid 
evaporation of moisture induces local congestions, 
causing symptoms of indigestion, colic, etc. The 
author believes that the hands should be included in 
the outer garment for the first five or six weeks of life 
after which time the bag may be replaced by the usual 
white nainsook or muslin slip. 

The bag will then serve as an ideal night garment 
for the first six months, and then the combination 
night drawers with feet are recommended because with 
these the lower extremities cannot be entirely un- 
covered. An entire change of clothing should always 
be made for the night. 

When necessary under the sack, additional protec- 
tion against cold is afforded by separate under gar- 
ments, as a light knitted shirt of silk and wool and a 
sleeveless slip of baby flannel. 

The best under garment for a baby is the knitted 
long sleeved shirt of mixed lamb's wool and silk. This 
shrinks less and is less apt to be irritating to the skin 
than all wool, and is warmer than the all silk. The 
same material, or a mixture of wool and cotton, is suit- 



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PATTERN FOR A SIMPLE MUSLIN SLIP. 

Draw 2-iiich squares on a paper over 36 in. x 16 in. and sketch the 
pattern as indicated. The gown is gathered at the neck and wrists 
on very narrow hands. The back is like the front except at the neck. 
(Only the top and bottom of the pattern is shown.) 



BABY'S CLOTHES 25 

able for the stockings, which should be long enough 
to pin to the diaper, which in turn is pinned to the 
shirt, thus leaving no portion of the child uncovered. 
No socks or bootees are needed. Over this the baby 
bag as described furnishes all the clothing necessary 
for moderately warm weather. 




A KNITWEAR INFANT SHIRT. 

In winter, or where the baby cannot be protected j^ 
from drafts, an additional garment without sleeves, winter 
reaching from the neck to ten or twelve inches below 
the feet, may be used next the shirt. Some mothers 
prefer to close this garment with a draw string, leav- 
ing the outer garment open and long enough to conceal 
the draw string effect of the skirt. 

Scotch flannel in its various dainty shades and pat- 
terns is excellent unshrinkable material for the bag, 
while soft, white baby flannel is suitable for the inter- 
mediate garment. No other clothing is necessary for 



Material 



26 CARE OF CHILDREN 

the first few weeks, unless a light shawl or quilt for 
carrying the baby from room to room, and a light silk 
scarf for occasional use to protect the head from pos- 
sible drafts. 




" THE FIRST LAYER." 
Diaper fastened to the shirt, and stockings with safety pins. 

The The diaper should be light with no more material 

Diaper \]^2M is absolutely necessary for the absorption of the 
discharges. Absorbent cotton, loose or in pads, pref- 
erably the latter, retained by a loose cheesecloth 
diaper, which is secured to the shirt by safety pins in 



BABY'S CLOTHES 



27 



front and behind, has been found to meet all require- 
ments. Where economy prohibits the use of absorbent 
cotton (which must be destroyed when soiled) a square 
of folded cheesecloth which can be washed may be 
substituted. 

No mention is made of the belly band for the reason 
that in the writer's opinion none is needed after the 
dropping of the cord until which time the cord dress- 
ing should be retained by a bias band of unhemmed 
flannel. This should be from three to four inches wide 
and about twenty-four inches long. Small safety pins 
may be used for fastening. 

In dressing the child, its head and neck should al- 
ways be supported by the hand or arm of the nurse. 
The weight of the young infant should never be al- 
lowed upon the unsupported spine as in the sitting 
posture, until five months, even in rugged children, and 
then only for a short time. Much harm results from 
too early use of the high chair and modern perambula- 
tor. 

SHORT CLOTHES 

Since all clothing limits to a certain extent the free- 
dom of movement so essential to nutrition and growth, 
the shortening of garments is obviously a gain in the . 
child's hygiene. The careful mother will be governed 
by the vigor of the child and its surroundings as well 
as the season in the matter of shortening its clothes. 

The first short clothes need differ in no material re- 
spect from the long clothes except in the length of the 
skirts. 



No 

BeUy 

Band 



Care in 
Dressing 



Time 

Dependent 
on Climate 



28 



CARE OF CHILDREN 



Waist 

and 

Drawers 



Foot 
Covering 



Moccasin 
Shoe 



When diapers are no longer necessary short knitted 
drawers are substituted, which, with the stocking sup- 
porters, are attached to a waist. In winter the waist 
should be of flannel, with or without sleeves, and the 
drawers of wool extending to the ankle. 

The shortening of the skirts necessitates extra pro- 
tection for the feet. Before the creeping time the 
knitted shoes without soles should be used. Later the 
more durable kid or chamois moccasins are neces- 
sary. Unwittingly, great cruelty is practiced in the 
conventional baby foot covering. 

Most of the prevailing deformities seen in the civ- 
ilized foot have their origin in infancy at a time when 
the rapid growth of this plastic member is easily re- 
tarded or perverted by the slightest degree of persist- 
ent pressure, as from a too short or too narrow stock- 
ing. Chalk the sole of the baby's foot- and press it 
against a damp slate or hard black surface and com- 
pare the impression with the outline of the ordinary 
baby shoes sold in the shops. 

The rapid growth necessitates frequent renewal of 
the moccasin shoe, which should be made for the feet, 
respectively, rights and lefts. They should fit the foot 
firmly only about the ankle and instep leaving ample 
room for the elongation and spreading of the toes. To 
secure proper adjustment shoes should be laced rather 
than buttoned. 

In learning to walk all the separate muscles must be 
educated to act in unison, hence every part of the foot 



BABY'S CLOTHES 



29 



and its toes must be allowed the utmost freedom. A 
snug shoe deprives some of these muscles of their op- 
portunity for education by binding the parts together 
to act as a unit instead of in unison. A stiff, unyield- 
ing sole interferes with the foot grasp of the ground. 





SHAPE OF CHILD'S FOOT AND PROPERLY SHAPED SHOE. 



As well might the child be taught to play the piano 
with hands encased in husking gloves as to attempt 
to gain perfect control of locomotion in the modern 
shoe. Hard shoe soles, like ancient sandals, are merely 
the outgrowth of the necessities of travel and have no 
place in the hygiene of infancy. 



30 



CARE OF CHILDREN, 



Bands 



No 
Constrictions 



Since vital capacity is best measured by lung expan- 
sion anything that interferes in the slightest degree 
with the movements of the ribs or diaphragm limits 
by so much vital capacity. A tight band around the 
abdomen interferes with the normal muscular move- 
ments of the stomach and bowels, weakens the ab- 
dominal walls and is frequently the cause of rupture 
both at the navel and groin. 

A constriction around the . hips, as from a tight 
diaper, retards the growth of the pelvis at a time when 
its substance is mostly cartilaginous and is undoubt- 
edly one of the causes of the prolonged travail so 
common to American mothers. 



CLOTHING FOR OLDER CHILDREN 



Proper 
Protection 



As the child grows older its style of dressing neces- 
sarily changes but certain facts must still be borne in 
mind. In the adult m.ore than three-fourths of the heat 
produced in the body is given off from the surface of 
the skin. In children the per cent of loss is probably 
still greater because the proportional surface of the 
body exposed is larger. One of the important func- 
tions of clothing is to regulate the movement of air 
streaming to and from the surface of the skin so as 
to retard the exchange of the warm air surrounding 
the body with the outer atmosphere without preventing 
it. The material, form and cut of the clothing all have 
to do with the proper performance of this function. 

All vital processes require a certain uniform tern- 



CLOTHING 31 

perature and interference with these is especially dis- 
astrous during the period of rapid growth. All en- 
deavor is made to maintain this for the infant, but it is . 
often overlooked for the child, where the need still re- 
mains as great. 

Clothing may become the cause of disease, either be- Materials 
cause of permitting sudden chilling of the body or be- 
cause of checking the circulation, respiration or per- 
spiration. The material should be selected with spe- 
cial consideration for the constitution, sex and age of 
the child; its power of heat regulation, and should be 
suited to the child's skin as well as so designed that 
it may permit liberty of movement. 

A word of caution should be given against the Bare Legs 
prevailing fad of bare legged children. The bare 
footed country boy, living out of doors all the time, 
clad only in shirt and trousers, may resist the ex- 
posure ; but there is danger to the otherwise warmly 
clad city child. When the stockings are left off and 
socks and low shoes substituted, for the sake of 
coolness near home, the custom is permissible; but 
in our fickle climate, when a change of weather or 
a thunder storm may lower the temperature from 
20 to 40 degrees, there is grave danger of a chill. 
This disturbs the circulation and may induce digest- 
ive disturbances, colds, or serious illness. A child's 
health should not be endangered by fad or fashion. 



SUREOUNDINGS AND CARE 

Protection The absolute wants of the infant are few and simple, 

and may be expressed in the two' words — Protection 
and Food. 

The infant must be protected from shock to which 
he is peculiarly susceptible. Normal function, as di- 
gestion, may be arrested by shock alone. Shock may 
occur from sudden changes of temperature, from noise, 
from blows or jars, from unaccustomed motion, from 
fear or anger, from intense light, and from excessive 
or prolonged pain. 

Protection should be secured from infectious or ir- 
ritating substances, either internal or external. The 
baby should not be subjected to rough handling or 
rough clothing ; it should be protected from liability to 
falls, or from blows especially on the head, and from 
wounds, scratches, bites or abrasions of any kind. Its 
surroundings should be as sanitary and antiseptic as 
possible in all particulars. 

THE NURSERY 

The multiplicity of these needs, not to mention the 
necessity of regularity in feeding, bathing, sleeping 
and so forth demands a systematic regime. Obviously 
this can best be secured through a separate nursery 
in which the means to the end are under full control. 
The '^^^^ room selected for this purpose should be in a 

Room quiet part of the house and should receive direct sun- 
light during as much of the day as possible. It should 

32 



THE NURSERY 



33 



be of sufficient size to secure ventilation without notice- 
able drafts, and furnished with special reference to an- 
tisepsis, hence carpetless, except for rugs which may 
be aired often ; curtainless^ except for light wash ma- 
terials ; devoid of moldings, pictures or fixtures which 
invite the lodgment of dust. The walls should be 
hard finished, preferably painted to permit of thorough 
cleansing with water or antiseptic applications. Double 
windows should protect against drafts and diminish 
direct radiation, and the system of heating and ventila- 
tion be under absolute control. The temperature 
should be from 75° to 80° F. during the first week after 
which time until the child is three months old about 
75° is recommended. After that it may be gradually 
lowered to 70° or even 65° at night. If the sleeping 
room be too hot and the rarified air fails to furnish the 
necessary amount of oxygen the child's vitality is low- 
ered by copious perspiration and his susceptibility to 
cold taking is increased. 

The nursery should preferably not be upon the 
ground floor, or on a level with the ground. Plumbing 
of any kind, even the best stationary washstand, should 
find no place in this room, and it is even better to se- 
lect a room not having direct connection with the fam- 
ily bathroom, as being more free from possible impure 
gases. 

In fact the room should contain nothing save the 
furniture necessary for the care of the infant. The 
metal crib should have a mattress filled with selected 



Furnishing 



Temperature 



Furniture 



34 



CARE OF CHILDREN 



Simple 
Articles 



First 
Year 



hair, and if any pillow is used it should be a very thin 
one of the same material. The mattress should be pro- 
tected by a thin rubber sheet placed under a quilted 
pad, and the covering should be of light wool. 

The different articles necessary in a nursery should 
be as simple, strong, light and plain as possible. Up- 
holstery is not desirable, and the furni- 
ture for the child should be suited to 
it. That is,, the tables, chairs, etc., 
that it is to use should fit the child 
not the older person. For the infant 
a bath tub (flexible rubber preferred), 
a bath thermometer, wall thermom- 
eter, scales, a double ewer, soap dish, 
on a low table, around which stand a 
high folding screen, are requirements. 

SL2EP 

A very young baby should sleep 
about twenty hours out of the twenty- 
four, in fact all the time when not 
being nursed, bathed or changed. No 
definite statement can be made as to 
the exact number of hours that a babe should sleep at 
a given age. No error will be made if the child is 
encouraged to sleep all that he will during the first 
year, being guarded against all noise and disturbances. 
Rocking and carrying are advised against as unneces- 
sary and possibly harmful. Certainly the jumping, up 
and down of a tiny infant in the mistaken belief that 




Weighing the 
Baby. 



SLEEP 



35 



its comfort is thus increased is ridiculous and not 
conducive to the best good of the baby. 

The sleep during the first few days is profound, but 
during the rest of the year it is easily disturbed. The 
position of the child should be changed during the 
longest sleep of the night. During the time when the 
bones of the head are hardening it is necessary to 
change the position of the baby, putting it first on one 
side, then on the other, that its head may not exhibit a 
flattening on one side. 

It is important to preserve great regularity in the 
hours of sleeping. No child under six years can 
afford to forego the daily nap, for which the shoes 
and outer clothing at least should be removed. 

A normal healthy baby with wants satisfied will sleep 
if comfortable and left alone. The fussy nurse or 
mother too frequently interferes with this function 
by over solicitude or mistaken notion that the baby 
wants companionship. It is better to put it in its 
crib and if possible go into an adjoining room, to 
accustom the child from the very beginning to sleep- 
ing alone. A few experiences will establish the 
habit and thus save the mother much time and 
strength as well as give the child better and more 
regular sleep. If the habit is fixed early no difficulty 
will be experienced. 

The custom of quieting the baby by the use of a 
blank nipple — ''soother" — is not only extremely un- 
sanitary, but is positively injurious. No more effi- 
cient means for introducing the ever present disease 



Regularity 



The 
Soother 



36 



CARE OF CHILDREN 



Thumb 
Sucking 



Vicious 
Circle 



germs into the system could be devised and many a 
mysterious infection may be explained by this 
practice. 

The habit of thlimbsucking, if long continued, very 
commonly induces changes in the shape of the mouth, 
teeth and jaws which amount in some cases to a de- 
formity. 

It is sometimes difficult to secure the necessary 
amount of sleep for children of active mentality or 
nervous temperament. Insufficient rest increases this 





DEFORMITIES CAUSED BY PROLONGED THUMB 
SUCKING. (Talbot.) 



Disturbed 
Sleep 



natural nervousness, which in turn, tends to prevent 
sleep, thus establishing a ''vicious circle" which robs 
growth, arrests development and finally destroys the 
child or wrecks his future life. 

The causes of disturbed sleep are so numerous and 
intricate that a brief enumeration of those most ap- 
parent must suffice. 



EXERCISE 



2,7 



Besides the physical discomforts due to bed or cloth- 
ing, insect bites, soiled diapers, constipation, skin irri- 
tations, excess of heat or cold, the child may suffer 
pain arising from internal conditions, such as earache, 
headache, intestinal disturbance, kidney colic, rheuma- 
tism (growing pains), sore mouth, or feverish condi- 
tions from various infections to which he is especially 
subject. Sleep disturbance is frequently due to inter- 
ference with respiration from catarrh of the nose or 
adenoid growths in the naso-pharynx or enlarged ton- 
sils. Here, also, may be mentioned worms, intestinal 
or rectal, and disorders of the genitals. 

The most common cause of restlessness, however, is 
indigestion due to improper food or methods of feed- 
ing. 

EXERCISE 

Exercise is absolutely essential to the normal growth 
and development of all the muscular structures. Lusty 
crying, if not prolonged, has a beneficial effect in the 
deeper respiration thereby induced. So stretching, 
kicking, squirming and waving of arms secure in a 
measure the needed exercise. Occasional massage is 
advised, the infant's expression of pleasure being one 
of the immediate evidences of its beneficial effects. 
After the creeping age the infant usually secures 
enough muscular exercise. The creeping pen, raised 
a few inches above the floor, is recommended for clean- 
liness and protection against floor drafts. 

It is essential that the baby have frequent change of 
air. Direct sunlight is needed, but it is advisable be- 



Cryingr, 

Kicking, 

Etc. 



Daily 
Outing 



38 



CARE OF CHILDREN 



Temperature 



Bran and 
Salt Bath 



fore taking the baby out of doors, that he be gradually 
accustomed to the outside air by opening the windows 
of the nursery for a short period each day, keeping in 
mind the need of additional clothing in cold weather. 

As a rule, the child should go out daily after the first 
month. The more weakly the child the greater the 
need. One caution should always be observe4 in his 
outing, protection from disturbance in securing his re- 
quisite amount of sleep. In fact, he may spend the 
greater part of the day in the open air, if properly pro- 
tected from zvind and sun. 

BATHING 

After the first week, the strong, healthy baby should 
be bathed daily. The temperature of the first baths 
should be about blood heat, 99° F. This may be re- 
duced gradually so that at the end of the month the 
temperature will be 95°, at six months 90° and 
by the end of the year 85° to 80°. It is well to finish 
bathing and drying the head before undressing the 
baby. Little soap is required and if the skin is unusu- 
ally delicate, that known as ''superfatty" is advised. 
The convenience of the double ewer is seen in having 
a supply of water free from soap for rinsing. Unless 
some irritation is present no powder need be used. 
The addition of the bran bag to the bath for children 
with a tendency to eczema, and of salt for its stimulat- 
ing properties to the infants needing it, is recom- 
mended. The daily bath should be given midway be- 
tween feedings and should not last longer than five 



BATHING 



39 



minutes. The toweling, though thorough, must be 
lightly and quickly done. 

The special care of the eyes, nostrils and mouth 
must never be omitted. As soon as the temporary 
teeth have appeared, they should receive as faithful at- 
tention as the permanent, since they are as subject to 
decay, and effects of digestive disturbances are greater 
in the child. Nothing should ever be introduced into 
the external ear with the exception of a twisted bit of 
gauze, gently applied for the purpose of drying. 

Not only are the genitals subject to local disorders 
but general mal-nutrition, obstinate reflex nervous dis- 
turbances and injurious habits are too often the result 
of their neglect. The daily bath should ensure 
thorough gentle cleansing of the delicate parts, which 
with the boy baby, should include the complete retrac- 
tion of the foreskin. If this is not accomplished by 
the end of the first month the physician should be con- 
sulted. 

In hot weather a rapid sponging with tepid water at 
night will secure for the baby a more restful sleep. 

The duration, as well as the frequency of the bath, 
should depend entirely upon the reaction ; blueness or 
chilliness of the surface, or signs of exhaustion are 
always indications of too frequent or too prolonged 
bathing. 

REGULATION 

The structure of the rectum and lower bowel in in- 
fancy, with the weakness of the abdominal walls, makes 



Special 
Care 



Duration 

and 

Frequency 



40 CARE OF CHILDREN 

extrusion of firm feces somewhat difficult. In the care 
of the infant no day should be allowed to pass with- 
out at least one free bowel movement. The estabhsh- 
ment of the habit of regular defecation is possible at 
a surprisingly early age. The regular practice of hold- 
ing the baby over the chamber before an evacuation 
will soon, by association, lead to defecation when 
placed in that position. If this practice is followed by 
the end of a few months the nursery chair may replace 
the diaper. 
Constipation ^^ obstinate constipation the daily movement may be 

secured only by the judicious use of the soap or glycer- 
ine suppository, or preferably, a small soap and water 
enema administered with the baby lying on his stomach 
across the lap. A copious injection is best given with 
the baby lying on his left side. 

In older children the rectum is usually empty. When 
the fecal mass descends into the rectum the uneasy 
sensations are produced which precede a normal 
evacuation. If this call is neglected the action of the 
rectum is reversed and the fecal matter is forced back 
again into the less sensitive portion of the large intes- 
tine where it may remain and harden by the absorption 
of its fluid constituents. By frequent repetition even 
the rectum loses its sensitiveness so that large accumu- 
lations of fecal matter may occur without exciting 
evacuative desire. The calls of nature must be re- 
garded as imperative. Their neglect may be the be- 
ginning of grave and irremediable conditions, such as 



REGULATION 41 

permanent distension of the lower bowel with loss of 
evacuative power. 




GIVING AN ENEMA. 

The lower end of the rubber sheet is placed in a pail. The bag of the 
fountain syringe should not be hung too higli. 



DEVELOPMENT AND aROWTH 
Importance The importance of a familiarity with the rate of 

growth during infancy and childhood can not be over 
estimated, as the irregularities in the growth ratio are 
frequently the first intimations of disturbed nutrition 
or developing disease. 

The following table shows the average heights and 
weights from birth to fourteen years: 

Table of Height and "Weight 



Boys. 


Age. 


Girls. 


Height. 


Weight. 




Height. 


Weight. 


Inches. 


Pounds. 


Inches. 


Pounds. 


19.75 


7.15 


Birth. 


19.25 


6.93 


24.75 


14.30 


5 months. 


23.25 


13.86 


29.53 


20.98 


1 year. 


29.67 


19.80 


33.82 


30.36 


2 years. 


32.94 


29.28 


37.06 


34.98 


3 years. 


36.31 


33.15 


39.31 


37.99 


4 years. 


38.80 


36.36 


41.57 


41.00 


5 years. 


41.29 


39.57 


43.75 


45.07 


6 years. 


43.35 


43.18 


45.74 


48.97 


7 years. 


45.52 


47.30 


47.76 


53.81 


8 years. 


47.58 


51.56 


49.69 


59.00 


9 years. 


49.37 


57.00 


51.68 


65.16 


10 years. 


51.34 


62.23 


53.33 


70.04 


11 years. 


53.42 


68.70 


55.11 


76 75 


12 years. 


55.88 


78.16 


57.21 


84.67 


13 years. 


58.16 


88.46 


59.88 


94 49 


14 years. 


59.94 


98.23 



Increase in body weight, length and the measure- 
ments of the different members bear normally a cer- 
tain constant relation at different periods of life. No 
period compares in rapidity of growth with that of the 

first three months. 

42 



DEVELOPMENT AND GROWTH 



43 



The loss of weight in the first three days is about 
ten per cent. This is usually regained by the end of 
the first week. The reason for this early loss is due 
partly to the loss of fluids from the interior as well as 
from the surface of the body, and partly to the con- 

Daily Weight Chart (Holt) 



First 
Loss in 
Weight 



Lbs. 


1 


2 


8 


i 


5 


6 


7 


8 


'9 


10 


11 


12 


13 


U 


15 


^6 


17 


18 


19 


20 


9X 

9 

8^ 
8M 

S'A 

8 

7^ 
7M 
7M 
7 
0^ 

6 

5^ 
5'A 
5X 










































































































































































































































































































































































































^ 




*^ 






























^-- 


.^ 












I 
















,r^ 


^- 






















\ 












^ 


X 


























\| 


V, 






^ 


^ 
































\ 




'^. 




















































































































■ 








































































' 


































1 









sumption of the stored body material before the first 
feeding takes place. 

The loss of weight is several ounces but at the end Rate of 
of the first week the baby has usually regained most ^"crease 



44 



CARE OF CHILDREN 



of the loss. After this the gain should be steady. Dur- 
ing the last three weeks of the first month and the en- 
tire second, this gain is about an ounce a day. During 
the third and fourth months about three-fourths of an 

Monthly Weight Chart (Holt) 



<D 


MONTH OFAGE. 1 


3 


1 2 3 4 5 6- 7 8 9 10 11 12| 
















1 




















■ 




































































































































































" 










































";>' 


■ 




















^^-- 




























































Li=p 


-L 







IT -- 








- J^ 


TT 




— 












































n 














>-" 








^ 














^'' - - 






































14 




-- "- 






















.< _ 






















:_"'' : 








































IZ 


















' 
















































19 














































r. z_: 


































~ 




















































, , 




:it 
































































































- 










" 






JX 


\ \ 






















Hj 


_ J^ 








... 





Gain in 
Length 



ounce a day, hence the normal infant has doubled its 
birth weight by the end of the fifth or sixth month. 
The gain decreases after this from two-thirds of an 
ounce to one-half an ounce a day as the infant grows 
older, until the weight has trebled at the end of the 
first year. 

The length of the average baby at birth is nineteen 
inches; this he doubles in four years. The increase 



Relative 
Growth 



DEVELOPMENT AND GROWTH 45 

during the first year (about half of the initial length) 
being nearly double that of any succeeding year. The 
average increase of the second year is about four 
inches, and from that time on to the age of eleven or 
twelve years from two to three inches annually. 

As the weight and height increase there is also a rel- 
ative value of dimension of the various parts of the 
body. The legs grow much more rapidly than the 
trunk but the girth of head and chest are of the great- 
est moment in determining the normal growth. The 
circumference of the chest, though smaller at birth, 
should exceed that of the head before the end of the 
second year. 

On account of its compressibility the shape of the ^j^^ 
chest depends largely upon the continous action of the ^^®^* 
muscles, hence the deformities so frequently seen as 
the result of retarded bone development. Any pro- 
longed pressure from improper position or constrict- 
ing clothing may add greatly to chest deformity. 

The increase in the circumference of the head in 

The 

early life is remarkable and like that of the body weight ^^ad 
is more rapid during the first year, increasing three 
inches during the first six months, a little more than 
one inch the second six months, three-fourths of an 
inch the second year and less than half an inch the 
third year. By the seventh year the head has attained 
nearly its full size. 

The fontanel diminishes in size towards the end 



46 



CARE OF CHILDREN 



Development 
of Powers 



Capacity of 
the Stomach 



of the first year and is ordinarily completely closed 
before the end of the second year. 

This period of growth also shows a constant de- 
velopment of acquisitions. The ability to shed tears 
generally comes at the age of three or four months. 
The new hair has begun to grow and increased pow- 
ers of digestion are developed. This is the time when 
the child begins to ''drool," a sign not of irritation 
caused by the cutting of teeth but merely ..an evidence 
of the increased flow of saliva due to development of 
digestive secretions. 

The characteristic coating of the baby tongue per- 
sists during the greater part of the nursing period. 
The roof of the mouth gradually becomes more arched 
with the development o*f the gums and teeth. The 
soft palate becomes ampler as it descends to its more 
verticle position, and the tonsils increase in size. 

The growth of the stomach is most rapid in the 
first half of the first year, of which the first three 
months exhibit by far the greater rate of increase. 
It maintains a very constant ratio of increase with 
that of body weight in the first year of life. 

The following table represents fairly the average 
capacity of the stomach at different ages : 



At birth 

End of 1st month 
End of 2nd month 
End of 3rd month 
End of 4th month 
End of 5th month 
End of 12th month 



1 ounce. 
2yi ounces. 
3^2 ounces. 
Ayi ounces. 
4% ounces. 
5 ounces. 
8 ounces. 



TEETHING 



A7 



TEETHING 



The development of the temporary teeth begins with 
the first formation of the jaws, about the sixth week 
of intra-uterine Hfe. At the time of birth the crowns 
of all the temporary incisors and canines are fairly 
advanced in calcification. 

The gums at first are smooth and firm and of 
a light pinkish color. The edges are rather sharp 
but grow broader after a few months, as the time 
of teething draws near. 

Of the temporary or milk teeth as they are called 
there are twenty, ten in each jaw ; two central incisors, 
two lateral incisors, two canines and four molars. The 
lower canines are called the stomach teeth. 

The teeth have a certain order of eruption, but 
variation is not uncommon. It is not a contin- 
uous process, but occurs in groups, with intervals 
of repose between successive groups. The lower cen- 
tral incisors appear from the sixth to the ninth month, 
their coming being completed in about ten days; then 
follows a resting period of two or three months, after 
which the upper incisors appear, both central and lat- 
eral. After an interval of a few months come the 
lower lateral incisors and first molars, four or five 
months later the canines and finally, about the second 
year, the second molars. 



Milk 
Teeth 



Order pT 
Eruption 



48 



CARE OF CHILDREN 



Order of the Eruption of the Temporary Teeth 



Permanent 
Teeth 



Teething 
Falacies 



Lower central incisors 
Upper incisors 
Ivower lateral incisors and 
first molars . - - 
Canines - - - - 
Second molars - - - 



6th to 9th month. 
8th to 10th month. 

15th to 21st month. 
16th to 20th month. 
20th to 30th month. 



Scarcely a year elapses after complete eruption of 
the milk teeth before absorption begins at the root and 
advances towards the crown which either falls off or 
is pushed out by the growth of the permanent tooth 
below. 

The permanent teeth, of which there are 32, may 
be divided into two sets, the ten anterior which -suc- 
ceed the milk teeth and six others that are added 
farther back in the jaw. During the growth of the 
teeth the jaw increases in depth and length and under- 
goes changes in form. 

Order of Eruption of Permanent Teeth 
First molars - - - - - 6th year. 

Central incisors 7th year. 

^Lateral incisors _ - _ - 8th year. 
First bicuspids - - - - 10th year. 

Second bicuspids - - - - 11th year. 
Canines - _ _ . I2th to 13th year. 

Second molars - - - 12th to 15th year. 
Third molars (wisdom teeth) 17th to 25th year. 
The lower teeth usually precede the upper. 

The prevalent notion that the eruption of the teeth 
is responsible for many of the disorders of infancy 
is not only fallacious but is productive of considerable 



TEETHING 



49 



barm. The terms "teething fits," "teething diarrhoea," 
"teething fever," etc., have no foundation in fact. 
Many infants have been lost for want of professional 
aid because of a mistaken notion that the acute dis- 
order was a necessary accompaniment of teething. 
Occasionally, however, the gum over the advancing 




Incisors^ — 




Permanent Teeth 



Milk Teeth 



DIAGRAM SHOWING USUAL ORDER OF ERUPTION OF THE 

TEETH, UPPER FIGURES REPRESENTING THE UPPER 

JAW, LOWER FIGURES THE LOWER JAW. 



tooth shows some swelling and the finger biting and 
the general peevishness of the child finds relief with 
the appearance of the tooth. As a rule, the so-called 
symptoms of teething are the appearance of teeth. 

The fact that the teeth make their appearance at a 
time when the transitional condition of infant develop- 



Confusion 
of Ideas 



50 



CARE OF CHILDREN 



Retarded 
Teething 



ment predisposes to a variety of disorders has led to a 
confusion of ideas. The universal dread of the ''second 
summer" (teething summer) is the outgrowth of the 
frequency of digestive disturbances at this time to 
which the eruption of the teeth bear little or no causa- 
tive relationship. 

No tooth eruption is ever retarded by the toughness 
of the gum. Its advance may be arrested by a tem- 
porary cessation in its growth due to nutritional dis- 
turbances, which of themselves produce the symptoms 
frequently ascribed to the slow coming tooth. 



Motor 
Development 



Taste 

and 

Touch 



DEVELOPMENT OF SPECIAL SENSES 

Schiller's observations on the motor nerves of the 
eye show the perfection not only of its mechanism, 
but also of its function, at an early period of infancy. 
This illustrates the method of growth in so much that 
this mechanism furnishes one of the channels of in- 
formation before the higher centers are capable of 
utilizing it, the process being an educational one. 

As the power and control of motion increases there 
is a development of senses which are the pathways to 
the mind. The nervous system of the infant shows 
well developed sensory and motor tracts, but the con- 
trol power of the higher centers is tardier in its 
growth. 

Taste and touch, especially of the lips and tongue, 
are fortunately the first of the special senses to show 



DEVELOPMENT OF SPECIAL SENSES 51 

activity, as these are necessary in the instinctive efforts 
of the young to obtain sustenance. 

Hearing, although demonstrated as present in the Hearing 
first twenty- four hours, is not developed sufficiently to 
differentiate between sounds before the end of the 
third month. 

Contemporary with the function of hearing is that vision 
of vision. Although sensitiveness to light and blinking 
on the near approach of objects, has been observed 
from the first weeks, still it is not until the end of the 
second month that the infant may recognize his mother 
by sight. 

At first the infant's movements are automatic or 
instinctive, the voluntary muscles showing only the 
purposeless, irregular, and unsymmetrical movements 
suggestive of the mere continuance of the intra-uterine 
existence. Co-ordinate, voluntary movements are first 
seen in the face and upper extremities, the hands in 
addition to grasping showing prehensile tendencies by 
the end of the third month. Objects are carried to the 
mouth at about this time. The many ineffectual at- 
tempts to locate the mouth indicate the vast amount of 
energy necessary to develop co-ordination. Although 
j;he apparatus including muscles and nerves is fairly 
complete, it requires multiple repetitions of sensations, 
impressions, volitions, and efforts at volition, before 
the establishment of such co-ordination as will ensure 
the performance of the most simple voluntary motion. 



52 



CARE OF CHILDREN 



Expression 
of Emotion 



Sittingr 



Standing 



Walking: 



About the end of the third month the voice is recog- 
nized as expressing emotions such as anger, fear or 
pleasure. About this time tears are observed to accom- 
pany the crying. It is interesting to note that perspira- 
tion is not common before the end of the third month. 

Following the development of the senses of sight 
and hearing to the extent of differentiating as to the 
color and size of subjects and the quality and direction 
of sound, we find co-operation of the muscles of the 
neck to a degree that the infant's head is held erect, 
balanced and turned at will. 

After the eighth month the infant should be able to 
sit for a short time without support and shortly after 
he begins to creep, roll or hitch towards desired ob- 
jects. About the tenth month he usually utters a few 
indefinite syllables, singly or repeated, as da da, ma 
ma, goo, etc. 

Between the tenth and twelfth months he shows a 
disposition to pull himself up on his feet, is usually 
able to stand by a chair and, exceptionally, may walk 
alone at the end of the first year. 

Infants exhibit a marked variation as to the time 
of these acquirements, dependent largely upon mus- 
cular vigor and education. A child left much alone 
will learn to develop his resources earHer. On the 
other hand, he will talk earlier if associated with other 
children. 

The subject of infant hygiene should not be dis- 
missed without reference to a practice that is as per- 



DEVELOPMENT AND GROWTH 53 

nicious as it is common, viz., the custom of regarding Th b b 
the baby as a plaything, an animated toy for the enter- SL?^\^. 

^ ' P' ■' , Plaything 

tainment of the family as well as a large circle of 
admiring friends. Children are fond of babies and 
never tire of stimulating their funny performances. 
The same is, unfortunately, true of parents and friends, 
but from a purely economic point of view, such amuse- 
ment is exceedingly expensive, and the mortality 
statistics are constantly increased for the amusement 
of the elders. Nervous and mental wrecks too fre- 
quently owe the origin of their disorders to want of 
repose in early infancy, due to injudicious stimulation. 
In this connection let it be understood that all evi- 
dences of mental precocity, called "smartness," should 
be regarded as danger signals and call for repression, 
rather than encouragement. Axiom — An infant dur- 
ing the -first year should neither he amusing nor 
amused. 



TEST QUESTIONS 

The following questions constitute the 'Vritten reci- 
tation" which the regular members of the A. S. H. E. 
answer in writing and send in for the correction and 
comment of the instructor. They are intended to 
emphasize and fix in the memory the most important 
points in the lesson. 



CARE OF CHILDREN 



Read Carefully, Place your name and address on the 
first sheet of the teat. Use a light gradeof paper and write 
on one side of the sheet only. L<eave space between the 
answers for the notes of the instructor. Use your own 
words and answer fully. Read the lesson paper a uumber 
of times before attempting to answer the questions. 



1. What special precautions should the expectant 

mother take? 

2. What are fontanelles and why should they be 

guarded ? 

3. What can you say of the bony development of a 

young baby? 

4. Give a brief outline of the first three days' care 

of the new born babe? 

5. How would you sterilize gauze? Why is this 

necessary ? 

6. Why is the baby so susceptible to temperature 

changes ? 

7. In clothing an infant what principles are to be 

observed? 

8. Describe the clothing suitable for baby's first six 

weeks. 

9. What may be the effects of tight clothing about 

the chest? Abdomen? Hips? 

10. How should a baby be put to sleep ? 

11. Name some of the commonest causes of dis- 

turbed sleep. 



CARE OF CHILDREN 

12. What objections are there to the ''soother"? 

13. Give your ideas of a nursery. 

14. What can you say of the effects of teething- upon 

the infant's health? 

15. During what period is growth most rapid? 

16. Why is famiHarity with the rate of growth im- 

portant ? 

17. Name the milk teeth and give their order of 

eruption. 

18. Why should the temporary teeth be cared for and 

how ? 

19. How do you interpret the statement "The senses 

are the pathways to the mind"? 

20. What objections are there to playing unduly with 

wnth the baby? 

21. Is any point not clear or are there any questions? 

Note. — After completing the test sign your full name. 




NATURE'S METHOD. 



'The act of nursing in its perfection is the result of the mutual co- 
operation of mother and child." 



CARE OF CHILDREN 

PART II 

Nutrition of the Child 



The subject of nutrition will always be of para- 
mount importance in the care of infants and children. 
As important as food is to supply energy for the mani- 
fold functions of adult life, it is doubly important 
during infancy, as during this period the demands 
for material for growth are most imperative. Since, 
therefore, the necessity for food is a double one dur- 
ing the developing period the importance of a thor- 
ough knowledge of all that pertains to foods and 
feeding cannot be exaggerated. 

Errors in diet, especially in infancy, are respon- 
sible for more deaths and cases of imperfect develop- 
ment than all other causes combined. In fact, the 
highest degree of infant mortality, especially during 
the summer months, is admittedly' due to mismanage- 
ment of the feeding. For this reason infants nursed 
at the breast are fortunate, as they escape many of 
the dangers to which artificially-fed infants are sub- 
jected. 

Children, as well as infants, require the best of 
nutrition, not only to meet the demands for material 
for growth, but also to furnish energy for the enor- 
mous work of training and educating the muscles, as 
well as for the development of the mind. The school 
pupil is a machine which not only converts raw mate- 

55 



Importance 



Diet and 

Infant 

Mortality 



Requirements 
of the 
Child 



56 



CARE OF CHILDREN 



Nature's 
Supply 



Early 

Nursing 

Advisable 



rial (food) into ideas, but also utilizes the food to 
construct the machine itself. What wonder, then, 
that many failures in the educational scheme must be 
attributed to the improper food supply. Because of 
imperfect nutrition, the imperfect machine not only 
furnishes unsatisfactory products, but is liable to mis- 
hap from its inherent weakness, as in the case of 
children who fall an easy prey to the various in- 
fections against which a well-nourished constitution 
would have proved a safeguard. 

NATURAL FOOD 

For the second "want" of the infant, namely, food, 
ample provision has been made by nature in an ap- 
paratus admirably adapted to its requirements. 

It is evident from the anatomy of the infant that 
he is especially adapted for the act of nursing. This 
the infant does instinctively. 

That no fully-developed milk is found in the 
breasts at the time of birth has been generally ac- 
cepted as conclusive evidence that the new-born child 
is in no immediate need of food. In fact, his deport- 
ment, if undisturbed, suggests the need of rest during 
the first forty-eight hours after birth. This belief is 
so universal that attempts at feeding before nature 
has furnished the supply have not met with general 
approval. 

However, it is recommended that the child be put 
to the breast early for two reasons : First, to stimu- 
late milk secretion; and, second, in the belief that the 



NATURAL FOOD 57 

first secretion (colostrum) promotes early evacua- 
tion of the bowel. Probably, by so doing, the child 
secures a little of the water so much needed at this 
time. 

The infant's habitual loss in body weis^ht durine i-oss of 

■' ^ ^ Weight 

the first days, as shown by tables on growth, has been 
regarded by some as unnecessary. In fact, it is 
claimed to be unfortunate, as interfering with the rate 
of subsequent growth. On this account some physi- 
cians recommend that nourishment be supplied during 
the first two days. This is usually unnecessary, how- 
ever. 

If the milk is slow in coming the baby may be given 
on the second day, every four hours, a tablespoonful 
of boiled water slightly sweetened with milk sugar. 
Caution: If this procedure lessens his eagerness for 
the breast, it should be discontinued, as much depends 
upon his early learning to nurse. 

Intelligent control or supervision of the act of suck- ^"^^^ ^o' 
ling averts or corrects many evil effects of its abuse of Nursing 
when left entirely to instinct. A few rules may be 
formulated, the observation of which is manifestly 
important in the hygiene of nutrition. 

(i) Asepsis must he observed, since one of the 
commonest causes of infantile disorders is infections 
introduced into the stomach. To this end the nipple, 
as well as the infant's mouth, for the first few weeks, 
must be cleansed before and after nursing. Milk re- 
maining exposed to the air shortly swarms with micro- 



58 CARE OF CHILDREN 

organisms, many of which cause disease when intro- 
duced into the digestive tract of the infant. Even 
the milk in the orifices of the ducts often becomes in- 
fected, hence the expression of a few drops is recom- 
mended before each nursing. 

In this connection it should be remembered that 
little or no hydrochloric acid is secreted in the stom- 
ach of the infant for several months. This acid in 
the gastric juices of the adult kills almost all the 
germs introduced with food. The absence of such 
a safeguard necessitates special care to exclude the 
germs of decomposition and disease from the intes- 
tinal tract of the infant. 
Frequency (2) The infant should he put to the breast every 

two hours during the day and once or twice at night 
during the first six zveeks. From six weeks to three 
months the interval between feedings should be in- 
creased to two and one-half hours. Between the third 
and sixth month the interval should be increased to 
three hours, giving seven feedings from 5 a. m. to 11 
p. M., inclusive. Night feeding may be discontinued. 
Six feedings a day should be sufficient for a child at 
six months. By the end of the year he may be accus- 
tomed to five. 

If sleeping, he should be wakened at the proper 
time for nursing until the habit becomes established. 

If the milk is abundant the breasts should be used 
alternately at first; later, the child may need both 
breasts at a feeding. 



NATURAL FOOD 



59 



Disturbed digestion is the common result of too 
frequent or irregular feeding. A certain definite time 
is necessary for the disposition of an ingested meal. 
After this an interval of rest is required for the proper 
re-establishment of the digestive function. Nothing 
is more abhorrent to nature than ''meals at all hours." 
The practice of the mother sleeping with the babe on 
her arm and quieting his restlessness throughout the 
night by offering the breast is, unfortunately, too 
prevalent, the result being that instead of receiving 
one definite feeding, the helpless infant is made the 
victim of a perverted instinct, and sooner or later may 
be permanently injured. 

The digestive process is one of varied stages, each 
dealing with a changed condition in the mass of food 
taken. It is apparent from this that some of the 
digestive secretions which make their appearance only 
as certain stages of the digestive process are reached, 
are not at all suitable for freshly ingested food. Prob- 
ably no vicious practice presents such vexatious prob- 
lems in our efiforts at correction as the results of too 
frequent feeding. 

After convalescence, the night nursing, like that of 
the day, should be accomplished with the mother 
seated in a comfortable chair, and as soon as through 
the baby should be "changed" if necessary, and re- 
turned immediately to his crib. In this way, the 
mother, as well as the baby, secures the maximum of 
unbroken rest. 



Meals at 
aU Hours 



Position 
in Nursinsr 



6o 



CARE OF CHILDREN 



Time of 
Nursing 



Mother to 
Control 



(3) The time occupied in nursing and the quan- 
tity taken should he controlled by the mother. The 
differences in the formation of the nipple and in the 
supply of milk in different mothers affects nursing 
more or less. There is a difference, too, in the nurs- 
ing energy of different infants, so that one infant 
will occupy half an hour in securing his dinner, while 
another may gorge himself in ten minutes. The act 
of nursing in its perfection is the result of the mutual 
co-operation of mother and child. A child can not 
properly nurse the passive breast of a sleeping or 
even inattentive mother. 

In breasts where the nipple formation is imperfect, 
making the nursing laborious to the infant or painful 
to the mother, or when milk secretion is tardy or in- 
sufficient, the mother should aid and encourage the 
babe by placing herself in full harmony with the 
pleasurable duty of the moment, and endeavor to 
secure a full response to the stimulating appeal of the 
tiny solicitor for a better supply. 

When the milk flows too freely, or in case of in- 
fants who nurse with such avidity that the process 
from beginning to end resembles a struggle against 
suffocation, the mother should control the outflow. 
This may be done by dexterous manipulation of the 
nipple between the fingers, by withdrawing from the 
mouth, or by diverting the baby's attention. 

It is safe to say that twenty minutes should be given 
to each nursing. Too rapid feeding throws into the 



NATURAL FOOD 



6i 



stomach a large quantity of food, with the result of 
over-distention, and hasty feeding invariably means 
07 '^rf ceding. 

Not infrequently the stomach resents this abuse by 
immediate regurgitation of a portion of its contents, 
which has led to the erroneous belief that the stomach 
is endowed with some quality which enables it to re- 
ject superfluous food. That this is a pernicious error, 
the frequent occurrence of gastric dilatation and intes- 
tinal indigestion is ample evidence. A little sterilized 
water given before nursing frequently prevents the 
over-ingestion of milk. Instinct is not always a guide 
as to the amount a child should nurse. 

(4) Give zvater systematically and freely. The 
baby's food, as will be shown when we consider the 
composition of milk, is made up of several widely 
different constituents. Although all of them are 
essential for perfect nutrition, one or more may be 
temporarily omitted without any immediate percep- 
tible interference with vital processes. In fact, one 
only must be present under all circumstances, and 
this is water. Without water no digestion, absorption 
or elimination is possible. Water enters largely into 
the composition of the infant's food, milk containing 
about 88 per cent. Water is essential to peptone ab- 
sorption, and many diseased conditions result from 
an insufficient supply. 

The restlessness of an infant is frequently only an 
expression of his thirst. Often unrequired and inju- 



Overf ceding 



Water 



Thirst 



62 CARE OF CHILDREN 

rious food is forced upon an unwilling stomach in 
response to the infant's appeal for water. 
Uric Acid Evidences of pain, usually ascribed to intestinal 

colic, are too frequently indicative of uric acid irri- 
tation and point to a need for more water. Fortu- 
nately the doping of the baby with carminative "teas" 
for the supposed intestinal spasm occasionally fulfills 
the needs of the child through the water of the de- 
coction. There is very little danger of giving a baby 
too much sterilized water, as it passes quickly out of 
the stomach and is absorbed. The water should be 
given at blood heat, either with a spoon or from a 
nursing bottle. 

Composition of Mother's Milk 

Milk is an emulsion of innumerable minute globules 
of fat floating in plasma. Among the globules are 
smaller particles of proteid matter. 

All the five principal classes of foods are found in 
milk, viz.: water, fats, proteids, carbo-hydrates, (milk- 
sugar), and salts. 

A symmetrical development requires not only the 
presence of all the constituents, but that they should 
maintain a certain definite quantitative ratio. 
Importance Although perfect nutrition is dependent upon the 
presence of all these food principles, life may be main- 
tained for a longer or shorter time if one or more be 
omitted from the diet, always excepting water. Thus 
an infant may exist for a time on water and sugar, as 
a solution of sugar of milk, or on water and proteids, 
or on water and salts; the result, however, in each 



NATURAL FOOD 63 

case invariably showing the deficiency of the constit- 
uents in impaired nutrition. (This is so well recog- 
nized that the absence of one or more of these essen- 
tial constituents is not infrequently determined by the 
condition of the infant.) 

The protcids furnish the only source from which Proteid^ 
the tissues obtain nitrogen, without which no proto- 
plasm can exist, nor cell life be possible. Insufficient 
nitrogen means interrupted gain in body weight, les- 
sened muscular force, anaemia with the weakened 
heart's action, arrested secretions and all the evi- 
dences of lowered nutrition. 

The fats are necessary, not only to maintain the Fats 
body heat, but to aid in the formation of bone and 
nerve tissue. Fat also maintains the healthy function 
of the lower bowel by promoting the passage of the 
faeces. A deficiency of fat produces lesults distinctly 
characteristic of impaired nutrition so uniform as to 
have been classified under the one term, rachitis. 

Sugar furnishes muscular energy and heat and in- sugar 
creases the formation and deposition of fat, sugar- 
fed babies frequently showing a remarkable plump- 
ness, even though fat and proteids are low in the food. 

The fourth group — the salts — principally those of Saitt 
lime, phosphorus, potash, soda and a trace of iron, 
forms a small but fairly uniform and very important 
percentage of the total constituents. 

A deficiency in any of these salts shows quickly in 
the impairment of the child's bony, nervous, muscular, 
circulatory or digestive system. 



64 



CARE OF CHILDREN 



Water 
Absolutely 
Necessary- 



Variation 
in Quality 



'rest of 
Food 



Were all the other ingredients present in noirnai 
mother's milk in proper proportions, the absence of 
water would render them valueless for food. It is 
only in a state of solution that these substances can 
undergo digestion in the intestines of the infant. The 
normal secretions of the digestive tract are relatively 
scant in proportion to the enormous work accom- 
plished during the growing period. Hence, the neces- 
sity for water at all stages.. Attention is again called 
to what has been said in the preceding pages, as the 
importance of the demand for water can hardly be 
overestimated. 

As before stated, normal mother's milk is made up 
of these five constituents ; moreover, they maintain 
a fairly constant percentage relationship. Frequent 
variations, however, are observed in normal milk, as 
in different mothers, or in the same mother at different 
times, or in the same mother in the different breasts, 
or in the same breast at the same nursing drawn at 
different times, as fore, middle and last milk. 

Of these constituents the percentage of fat is sub- 
ject to the widest variation ; next, the proteids ; the 
milk sugar and salts showing little change. Nor 
would these variations be considered as indications of 
abnormality, the only criterion being its effect upon 
the child. An infant at the breast, digesting well, 
gaining steadily in • weight and strength, is getting 
good milk, regardless of what the analysis may show. 
It is a fact of common observation that the breast at 



CHANGING QUALITY OF FOOD 



65 



which one infant thrives may not meet the require- 
ments of another child of the same age. 

CHANGING THE QUANTITY AND QUALITY OF THE MILK 

Milk secretion is subject to variations in quantitv 
as well as in quality. In the majority of mothers it 
is regulated to meet the requirements of the infant, 
although instances are not uncommon in which the 
quantity is insufficient. On the other hand, it fre- 
quently occurs that the mother may, successfully nurse 
two infants, as in cases of twins, or in wet-nursing in 
foundlings' homes. From this it may be inferred that 
in some mysterious way, and to a limited extent, the 
supply is regulated by the demand. The growth of 
large babies is relatively more rapid than that of 
smaller ones, and it would appear that to a certain 
degree there is an automatic adjustment of the quan- 
tity of milk to the needs of the child. 

It is a question whether the daily quantity of milk 
can be increased by any medical agent. However, the 
milk secretion is quite sensitive to many influences, 
both as to its quantity and composition. 

A so-called ''dry diet" in which there is a deficiency 
of water, usually diminishes the secretion, while, on 
the other hand, it may be increased by a liberal allow- 
ance of water, milk and other fluids. 

The secretion of milk, when scanty, may be m- 
creased by any agency that increases normal meta- 
bolism (digestion and assimilation) ; as diet, exercise, 
massage, electricity, fresh air, sunlight, congenial 



Variations 
in Quantity 



Increasing 
Quantity 



66 



CARE OF CHILDREN 



Mental 
Attitude 



Changing 
the Fats 



surroundings, freedom from physical discomfort and 
an equable temperament. 

Sudden emotion, as grief, anxiety, anger, fear, or 
anything that produces shock or profoundly impresses 
the nervous system, may not only diminish the secre- 
tion, but occasionally cause total suppression. 

Regularity should be observed in putting the child 
to the breast, even though there be little evidence of 
milk as the secretion is undoubtedly promoted by the 
act of nursing. 

Attention is again called to the mental attitude of 
the mother during nursing, as influencing the quan- 
tity of milk. It must not be forgotten, however, that 
over-anxiety to produce defeats its very object. 

Loss of fluids from any cause, as copious perspira- 
tion, menstruation or diarrhoea, may lessen the 
amount of the milk. 

The relative proportion of the constituents of the 
milk may be influenced by variations in the hygiene 
of the mother, especially in the diet. The former be- 
lief that the fat of the milk was increased by the fat 
eaten has been repeatedly disproved by actual experi- 
ment. It is believed to-day that the proportion of fat 
in the milk depends largely upon the amount of pro- 
teid in the mother's food, increase or decrease in the 
latter causing a like change in the former. The mere 
eating of proteid food, however, is not sufficient to 
produce a "rich milk," since thorough digestion and 
assimilation are essential to fat production. 



CHANGING QUALITY OP POOD 



67 



Fat may be scanty in the milk, not only from an in- 
sufficiently nitrogenous diet, but also as a result of 
excess of fats in the food. Examples are not wanting 
of mothers who in their efforts to enrich their milk 
defeat this object by drinking too much rich milk or 
cream. 

A poorly nourished or rachitic infant is frequently 
seen at the breast of the mother whose diet consists 
largely of starchy foods. The substitution in this 
case of a diet of eggs for breakfast, meat for dinner 
and supper, with a cup of beef broth between times, 
and a limited supply of vegetables and sweets will 
almost invariably show an increased percentage of fat 
in the milk, with subsequent improvement in the 
nutrition of the child. 

It occasionally occurs that tlie infant shows the 
effects of excessive fat in the so-called "fatty diar- 
rhoeas," in which fat is seen in the diapers in glisten- 
ing masses or floating on the surface of the washing 
water. Again, in the ''spitting babies," who regurgi- 
tate their food shortly after nursing, analysis of moth- 
er's milk shows sometimes as high as seven or even 
nine per cent fat. In such cases meats should be re- 
stricted and vegetables and breadstuffs substituted in 
the mother's diet. 

The proteids are rarely low except in cases of ex- 
haustion or debility, as from sickness or insufficient 
food. In this condition the milk is poor and watery, 
there being a deficiency in all the solids. In such 



Too Much 
Fat 



Changing- 
the Proteidc 



68 



CARE OF CHILDREN 



iJiXcessive 
Proteids 



Colostrum 
Milk 



cases the hygiene of the mother requires a liberal diet 
with all the accessories for the improvement of her 
general nutrition. Here nitrogenous foods are neces- 
sary to increase proteids in the milk. It may happen 
that the mother's milk in cases of debility shows an 
excess of proteids with a deficiency of other constitu- 
ents, the debilitated infant exhibiting evidences of in- 
digestion, in constipation or in diarrhoea and vomit- 
ing. 

Excessive proteids may appear, also, in the milk of 
the overfed mother of sedentary habits for whom ex- 
ercise in the open air with reduction of diet is re- 
quired. Idleness and discontent may be replaced by 
congenial occupation, to the improvement of the milk 
in this respect. The relief of constipation or the alle- 
viation of any bodily discomfort may alone be suffi- 
cient. 

Violent agitation of the nervous system of the 
mother may change the quality of the milk almost in- 
stantly. Quite frequently, under these circumstances, 
it resembles colostrum in its changed proteids, low 
fat and colostrum corpuscles. Instances are known 
where convulsions and even death to the nursling 
have followed. 

The secretion of the colostrum milk sometimes fol- 
lows undue fatigue, excitement, anger, grief, also 
menstruation and conception. Disturbances of diges- 
tion in the infant are frequently the first intimation of 



CHANGING QUALITY OF FOOD 69 

pregnancy in the mother. In the event of the above 
disturbances, the child should be removed from the 
breast and artificially fed until the milk approaches the 
normal as shown by analysis. Meanwhile, the breasts 
should be emptied regularly by the breast pump, 



SUCTION BREAST PUMP. 

Both quantity and quality of the milk are influenced Effect 
by the frequency of nursing. Poor milk usually re- of Nursing 
suits from irregular intervals in nursing. The more 
frequently the breasts are emptied, the higher will be 
the percentage of solids, especially the proteids. The 
infant, restless from indigestion induced by excess of 
proteids, often is unfortunately given the nipple at 
short intervals to quiet him. The result is increased ' 
indigestibility of the milk from greater excess of pro- 
teids. What is needed is water for his thirst, rest for 
his stomach and rest for the mammary glands. 



70 CARE OF CHILDREN 

In conclusion, a table may best express a summary 
of the means at our command for regulating the com- 
position of mother's milk. 

The percentages of sugar and salts vary but little. 

The Percentage of Proteid may be Increased by 

Increased frequency of nursing. 

Increased liberality of proteid food. 

Insufficient exercise. 
The Percentage of Proteid may be Diminished by 

Diminished frequency in suckling. 

Diminished proteid food. 

Increased exercise. 
The Percentage of Fat is Increased by 

Increased proteid diet. 
The Percentage of Fat is Diminished by 

Deficiency of proteid food. 

Excess of fatty foods. 

Fasting. ' 
The Percentjige of Water is Increased by 

Increased fluid diet. 
The Percentage of Water is Diminished by 

Saline cathartics. 

Diminished fluid diet. 

Care of The uursiug mother must keep herself In the best 

the Mother 

possible physical' condition if she would have a healthy, 
contented baby. She should take daily exercise in the 
open air, simple food, and plenty of sleep. She should 
keep free from worry, avoid too much excitement, un- 
due fatigue and late hours. Constipation should be 
remedied. 



NATURAL FOOD 71 

VOMITING 

Vomiting should never be regarded as trivial. It 
should be to the baby feeder as the red light is to the 
engineer. A careful consideration of all the condi- 
tions may determine the cause, which should always 
be sought, and when found removed. With rare ex- 
ception, this cause will be found in the non-observ- 
ance of the rules of hygiene outlined in these lessons. 
Although almost invariably the vomiting of infancy 
is due to dietetic errors, it occasionally ushers in some 
of the graver diseases, such as scarlet fever, measles, 
meningitis, cholera infantum, etc. 

Whatever be the cause, no mistake will be made if Diminish 

the Food 

the food is diminished in quantity or withheld entirely ^ 
for a time. 

The regurgitation of a small quantity of milk 
directly after a feeding is not always an indication 
of serious trouble, but may result from overfeed- 
ing and careless handling. 

WEANING AND STTBSTITTJTE FEEDING 

The question of substitute feeding is of secondary 
importance only to that of lactation. Conditions may 
develop at any time which render breast feeding im- 
practicable. Progressive changes occur in the con- 
stituents of breast milk which render it, after a time, 
insufficient to furnish the material demanded by the 
rapid growth of the infant. Moreover, the presence 
of several teeth, the changes in the salivary secretion, 



72 



CARE OF CHILDREN 



Period of 
Lactation 



Do Not 

Wean for 

Slight 

Cause 



Early 
Weaning 



as well as in those of the stomach and pancreas, indi- 
cates preparation for digestion of a different class of 
foods. 

The changes in breast milk show considerable vari- 
ation as to the time of their occurrence in different 
women. Thus, one mother may have exhausted her 
power to produce good milk by the end of the seventh 
month ; while another woman may continue to furnish 
good milk until the fifteenth month. 

The growing tendency to recommend weaning upon 
the slightest pretext suggests the need of more em- 
phasis upon the injunction not to substitute artificial 
for breast feeding until it is clearly proven that the 
latter can not be made to agree. However, the infant 
should not be deprived of his right to a fair start in 
life by being confined to the breast which fails to fur- 
nish all the requisites for normal nutrition. 

Aside from the normal time of weaning, which 
should rarely be deferred beyond the twelfth month, 
occasions may arise during the first year when the 
decision must be made as to whether the child can 
thrive on the milk of his nurse. Transient disturb- 
ances due to the milk should not be considered suffi- 
cient cause for rejecting the breast, since many tem- 
porary disagreements may be corrected by attention 
to the hygiene of the mother or child. 

The indications for early weaning, so far as the 
infant is concerned, are evidences of deficiency in 
normal development; which is frequently best shown 



WEANING 



73 



by a failure to gain in weight. However, weight gain 
is not always evidence of normal nutrition, as many 
rachitic babies make fat rapidly. 

The process of weaning should be gradual, the in- 
fant having been accustomed to supplemental feeding 
commencing with one a day and increasing the num- 
ber through a period of several weeks. 

The food selected for the supplemental feeding 
should at first be weaker than that for an artificially- 



First 

Substitute 
Food 




BREAST PrTMP WITH BULB. 



fed infant of the same age and development. This 
is particularly important in the proteids, which in 
cows' milk are much more difficult to digest. As the 
skimmed milk contains most of the proteids, about 
one-half of this constituent may be replaced with 
water in the food formula for an infant of the same 
age. If the new diet is tolerated, the skimmed milk 
may be increased cautiously from day to day until the 
regular formula is used. 

The season or time of year must be considered in 
the weaning, as radical food changes should not be 



Time of 
the Year 



74 



CARE OF CHILDREN 



Menstruation 



made at the commencement of or during the heated 
term, at which time infants are especially susceptible 
to digestive disorders. The cutting of an unusually 
troublesome tooth might well delay the change in 
food. 

A child should be immediately 
removed from the breast upon the 
appearance of acute infectious dis- 
ease in the mother or upon well- 
grounded suspicion of the exist- 
ence of syphilis Or tuberculosis. A 
suitable w^et nurse should be se- 
cured if possible, in case the infant 
is free from syphilitic infection. 

The development of abscess ren- 
ders the affected breast unfit for 
nursing while suppuration con- 
tinues. 

Menstruation frequently disturbs lactation. Its 
early appearance may not require weaning, but its 
regular return should suggest its advisability. It is 
usually best to give substitute feedings during the 
first day of a period. 

The occurrence of conception is an indication for 
the immediate removal of the child from the breast, 
as this condition renders the milk insufficient, if not 
positively injurious. 

When it becomes evident that substitute feeding is 
necessary, the question what shall be substituted is of 




Artificial Nipple for 

Use with Sore 

Breasts 



SUBSTITUTE FEEDING 75 

the greatest importance. Errors in the management 
of substitute feeding are probably responsible to a 
greater extent than any other eause for the high infant 
mortality. 

The best substitute is the wet nurse. The draw- The wet 

1 , . 11. Nurse . 

backs to wet-nursing are many and extremely trymg, 
and it is probably on account of these that this substi- 
tution is not more frequently resorted to in this coun- 
try. The wet nurse should be chosen with reference 
to her temperament, the quality and quantity of her 
milk and her freedom from syphilis or tuberculosis. 
She should be examined by the family physician and 
accepted only upon his recommendation. 

Should the first wet nurse's milk fail to agree, it 
need be no cause for discouragement, as in some cases 
repeated trials are necessary. In case a wet nurse is 
not aA^ailable it will become necessary to adopt arti- 
ficial feeding. 



ARTIFICIAL FEEDING 

More has been written and said concerning artificial 
feeding during the past ten years than all other pedia- 
tric subjects combined. 

Having studied natural feeding, we should have a 
fairly practical knowledge of the quantity and quality 
of food required at different ages, and also the time 
and method of feeding. That we should keep close to 
nature, both in the composition and physical proper- 
ties of the food, seems hardly necessary to state. Yet 
we see infants fed ( ?) on compounds differing so 
widely from those which their organs are prepared to 
digest that it is surprising so many survive. 
DigStfon The stomach of the infant at birth was found to be 

little more than a receptacle for food in which the 
action of rennet coagulating the milk, prepares it for 
the first step in the digestive process. 

As the infant grows the capacity of the stomach in- 
creases rapidly, its walls thicken, the glands develop 
and pepsin and hydrochloric acid secretions gradually 
become more abundant. It is not, however, until after 
the sixth month that the salivary and pancreatic secre- 
tions develop to any great extent the power of con- 
verting the starch into sugar. 

This conversion is necessary before cereals may en- 
ter largely into the food, as nature has made little or 
no other provision for the digestion of starch. 

During the latter half of the first year the stomach 
empties itself of a digested meal in two or three hours, 

76 




COVERED MILK PAIL IN USE AT CONNECTICUT 
AGRICULTURAL COLLEGE 

The first jets from each quarter ot the udder are drawn into a cup 
and discarded 




< o 

«'^ 

■+-> 

^ E 

q| 

>H ex 
o 



ARTIFICIAL FEEDING 



11 



the time depending upon the quaHty of the food taken, 
cow's milk requiring the longer time. 

That a very large percentage of the food is ab- 
sorbed in the normal infant normally fed, is shown by 
analysis of the faeces. As a result of observations 
upon infants fed wholly upon milk, it is stated that 
the faeces consist of 84 to 86 per cent water ; that 
digestion and absorption of proteids in the alimen- 
tary canal are so efficient that but little is lost ; that 
the whitish flakes and clots, nearly always seen, are 
composed largely of fat, fatty and lactic acids in com- 
bination with lime. 

Milk acids are always found and to their presence 
are attributed the slightly acid smell and reaction. 
Fermentation of milk sugar leads to the development 
of carbon-dioxide and hydrogen, which are the prin- 
cipal gases in the intestinal tract of a healthy infant 
fed purely on milk, foul-smelling gases being absent. 

Though the amount of faeces varies much in in- 
fants, yet three per cent of the milk taken is the aver- 
age proportion. The fecal discharges after the first 
few days are an orange yellow, frequently turning to 
green on exposure to air, . are of the consistency of 
batter and homogeneous throughout. They average 
from three to five movements daily. These character- 
istics vary somewhat with the quality of food taken 
and the completeness of the digestive process. 

The urine increases from about six ounces at the 
end of the first week to eight or sixteen ounces at six 



Completeness 
of Digestion 



Fecal 
Discharges 



78 



CARE OF CHILDREN 



Essentials 

in Substitute 

Feeding 



Composition 



Anti-Scorbutic 



Quantity- 



months. There is considerable variation, however, de- 
pendent upon the secretions from the skin and bowels 
and the amount of fluids taken. The marked tend- 
ency to urination is variable, occurring sometimes 
every hour during the day and twice or thrice at 
night, while at othei times several hours may elapse 
without urination. The urine is usually light in color, 
of low specific gravity, 1.004 to i.oio, and in health 
rarely stains the diaper. 

A few ''essentials" from Cheadle may be of value 
in assisting the student to a practical application of 
some of the principles already indicated. 

First — The food must contain the different ele- 
ments in the same proportions as found in human milk, 
viz. : proteids, i to 2 per cent ; fats,, 3 to 4 per cent ; 
milk sugar, 6 to 7 per cent ; salts, tV per cent ; water, 
88 per cent. 

Second — It must possess the anti-scorbutic prop- 
erty. Infants at the breast very rarely suffer from 
scurvy, that disease being found among those fed 
upon condensed or sterilized milk, or upon dried or 
evaporated preparations. Prompt recovery usually 
occurs with the food unchanged, except the discon- 
tinuance of sterilization. Fresh milk possesses this 
anti-scorbutic element, but not in large proportion, 
for milk in extreme dilution will not prevent the de- 
velopment of scurvy. 

Third — The total quantity in twenty-four hours 
must represent the equivalent in nutritive value of 



Animal 
Origin 



ARTIFICIAL FEEDING 79 

from one to three pints of human milk, according to 
age. 

No fixed arbitrary rule can be given for all chil- 
dren. Careful observation of the infant as to whether 
he rejects some of his food soon after taking it or 
seems hungry half an hour after feeding, may prove 
a guide. The best indication that he is receiving his 
full equivalent is a steady weekly gain of two or three 
ounces or more in the early months. 

Fourth — It must not be purely vegetable, but 
must contain a large proportion of animal matter. 

Most vegetable substances are deficient in proteids 
and yield but a small quantity of fat. Moreover, it is 
known that the infant does not assimilate them as 
easily and fully as those derived from animal sources, 
even though these ingredients be supplied in the 
proper percentages. 

Fifth — It must be in a form suited to infantile Fluid 
digestion. 

The digestive organs, it will be remembered, have 
only recently assumed their function and are de- 
signed to deal solely with the bland, dilute and easily- 
dissolved nutriment of mother's milk. In the natural 
method of feeding, the infant gets his nourishment in 
the same form at every meal ; so in artificial feeding 
variety is not desirable. 

As the walls of the stomach are lacking in muscular 
power and the glands produce but little secretion, it 
is evident that it is not right to ask this organ to deal 



8o CARE OF CHILDREN 

with large masses of solid or semi-solid matter. Sol- 
ids can be digested only in a state of minute subdivi- 
sion. 

sterile Sixth — It miist he as nearly sterile as possible. 

Infants are extremely susceptible to stomach and in- 
testinal disorders, having little resistance to bacteria 
and their poisons. The products of fermentation are 
highly irritating and the sensitive, unstable nervous 
system of the infant may be profoundly affected there- 
by. The gastric secretions of the infant do not con- 
tain the protecting hydrochloric acid of the adult. 

*^Mii'k Cow's milk, on account of its cheapness and the 

abundant supply, is the most available substitute for 
mother's milk. The proneness to stomach disorders 
and the great mortality among the bottle-fed babies 
has led to a systematic study of cow's milk. As a re- 
sult of this study, some of the reasons why cow's milk 
does net meet all the requirements of the infant may 
be shown. The results of recent analyses give the con- 
stituents of cow's and mother's milk as follows : 

Compositicn of Milk 

Average Composition. Cow's. Mother's. 

Per Cent. Per Cent. 

Specific gravity 1.032 1.030 

Total solids 14-13 13-12 

Proteids 4-00 1.50 

Fat 400 4-00 

Sugar 4-50 6.50 

Salts 0.70 0.15 

Reaction Acid* Alkaline 

Bacteria Swarming with* .... None 



♦This refers to cow's milk as it reaches tlie consumer. 



ARTIFICIAL FEEDING 



8i 



It will be seen at a glance that the milks differ but 
little in specific gravity, in the quantity of their total 
solids and water, and in their percentage of fat ; more 
widely in their salts, sugar and proteids ; most widely 
in regard to chemical reaction and presence of bac- 
teria. 

The sugar in cow's milk is identical with that in 
breast milk. The fats are nearly the same, although 
those in breast milk are in more finely divided par- 
ticles and more easily digested. It is in the proteids 
that the greatest difference comes, the percentage be- 
ing much higher in cow's milk and the composition 
different. The proteids of both cow's and mother's 
milk are made up chiefly of casein and albumen (lac 
albumen), but the relative porportion of the casein to 
the albumen in cow's milk is about 6 to i, and in breast 
milk is about i to i. Even the casein in the two milks 
is not of identical composition ; that in cow's milk 
coagulates in much denser and less digestible clots. 
The nitrogenous substances called ^'extractives" differ 
in the two milks and the mineral parts — the salts — are 
not the same. Thus it is apparent that cow's milk 
can not be so modified as to be identical w^ith mother's 
milk. The best we can do is to approximate nature's 
supply as nearly as possible. 

Most of the disturbances of infants' digestion are 
traceable directly to proteids; their excess in cow's 
milk being the principal factor in its disagreement. 
It is usual to reduce the percentage of proteids by the 
addition of water. 



Differences 
from Mother's 
Milk 



Proteids 
Cause of 
Trouble 



CARE OF CHILDREN 



Modified 

Milk 

Laboratories 



Bacteria 

the Cause 

of Disorders 



Safe Milk 



In this dilution, however, the nutritive value of the 
milk suffers from a diminution of fats and sugars. 
Consequently it is necessary that the percentage of 
sugar and fats be maintained by the addition of sugar 
of milk and cream. 

Laboratories for this modification, like those of the 
Walker-Gordon Co.,* have been established in the 
leading American cities, to which orders are sent for 
definite percentages of modified milk, as drugs are 
ordered by prescription from a pharmacy. The physi- 
cian may, at will, control the amount of different in- 
gredients, varying tlieir percentages to meet the vary- 
ing requirements of the little patient. 

That many disorders of infancy are due to the 
presence of bacteria in cow's milk is no longer a mat- 
ter of doubt. In addition to infection from the pos- 
sible presence of such germs as those of tuberculosis, 
typhoid fever, scarlet fever, diphtheria, etc., it should 
be emphasized that the proneness of cow's milk to 
decomposition with its effects upon the nursling is 
one of the g:reatest dangers of milk feeding. Hence, 
the hygienic dairy management becomes a question of 
the highest importance. 

It has been proved that milk production may be so 
guarded as to furnish a product comparatively free 
from bacteria. As an example of what scrupulous 



* The Walker-Gordon Co. have laboratories or stations in the follow- 
ing cities: New York, Boston, Chicago, Philadelphia, Washington, 
Baltimore, Buffalo, Cincinnati, Cleveland, Detroit, Grand Rapids, 
Milwaukee, Pittsburg, St. Louis, Atlantic City, Princeton, Newark, 
Elizabeth, Montreal, Can., Ottawa, Can., London, Eng. 



ARTIFICIAL FEEDING 83 

care and cold can accomplish in producing bacteria- 
free milk, may be mentioned the exhibits of a number 
of American dairies at the Paris exposition in 1904. 
Milk and cream were shown that remained sweet for 
several days after the journey of ten days or more. 
The officials found it hard to believe that no preserva- 



O 






c5 0-06-00,;- o-^(j-jF 

a ^ O O b ^^ 

MICROSCOPIC APPEARANCE OF MILK. 

a. Pure milk. h. After standing in a dirty dish for some hours in a 
warm room, showing many varieties of bacteria. 

lives had been added or treatment given until con- 
vinced by analysis and by proof. 

The same care in the selection of the cow Is rec- selection 
ommended as in the selection of the wet nurse ; the of Cows^ 
same details in her hygiene as well as in the antiseptic 
care of the milk will insure milk that is practically 
sterile. 

In the choice of the family cow three requisites at 
least should be kept in view. First: The quality of 
the milk. Second: The constitution of the animal, 



84 



CARE OF CHILDREN 



Jerseys 



her hardihood and freedom from disorders and her 
adaptability to variations in climate and food. Third: 
Her temperament and freedom from disturbances due 
to accidental causes. 

Of many types distributed throughout the country 
we will discuss but three, viz., the Jersey, the Hol- 
stein and the Durham. 

The Jersey gives a fair quantity of milk, exceed- 
ingly rich in cream. In-breeding, however, has made 



I 2. a 4 5 6 7 8 a 10 1112 13 1415 I617I&19S021 22 



Holsteins 



Durhams 

























































































. 


^ 


\ 






/ 


s 






/ 


^s 




/ 


s 






/ 








^ 








s 




/ 






\ 


/ 










N 


r^ 






\ 


^ 























































































6% 

^ 



VARIATION IN PERCENTAGE OP CREAM 
IN ONE COW'S MILK. 

her delicate and quite susceptible to diseases, as tuber- 
culosis, etc., and though quite gentle she is nervous 
and sensitive. The fats of Jersey milk differ some- 
what from those in other milks and the globules of 
fat are larger, thus making it less digestible. 

The Holstein is docile, hardy and the greatest of 
all milkers, but the milk is low in the percentage of 
cream and proteids. 

The third type, the Durham, undoubtedly is the 
best, as she is a good feeder, of placid temperament, 
and yields a large quantity of very good milk. 

In the best of cows, however, the milk varies from 
time to time in quantity and quality under the chang- 



-^/s 




\ ^ 



&r^ 



4^# ■' 




FAT GLOBULES IN HUMAN MILK 
Storrs Agricultural Experiment Station, Bulletin No. 31 




y- t^t 



'h ^^^^ 8 



'X'^^* 



'<A' 



o, 






Od 



>y 



./*' 






L Otx / 



.''/ 



^»:k.. :: 



FAT GLOBULES IN HOLSTEIN MILK 






FAT GLOBULES IN JERSEY MILK 



ARTIFICIAL FEEDING 



85 



ing influences of food, care and surroundings, so that 
the popular idea of the great value of a "one cow's 
milk" supply for the baby is erroneous. The mixed 
product of a herd secures a greater uniformity in the 
quality and the percentage of constituents. 

The selection of the dairyman should depend upon 
his known methods of handling his herd and its prod- 



The Baby' 
Milkman 




THE COVERED MILK PAIL. 

ucts. Does he select his cows upon the principles 
above enumerated? Is his herd regularly inspected 
by a competent veterinarian for evidences of tuber- 
culosis or other disease? Are the animals properly 
fed, watered and pastured? Are they comfortably 
housed in stables that may be cleaned daily and regu- 
larly whitewashed? Are the milkers kind, intelligent, 
cleanly and conscientious? Is the cow cleaned and 
her udder washed before each milking? Is the first 
teat full of milk discarded and the remainder received 



86 



CARE OF CHILDREN 



Importance 

of 

Refrigeration 



Certified Milk 



in a sterilized pail through a cover of cheesecloth ? Is 
the milk immediately strained, bottled and placed in a 
cooler which rapidly reduces its temperature to 40° 
F? 

Rapid cooling and refrigeration are fully as impor- 
tant as cleanliness in the production of safe milk, for 







DIAGRAM SHOWING THE RATE OF INCREASE OF 
BACTERIA IN MILK. 



a. Single Bacteria. 



b. Increase in 24 hours at 50° F. 
24 hours at 70° F. 



c. Increase in 



the few bacteria which are present in even the most 
carefully-cared-for milk multiply with enormous ra- 
pidity at 70° F., while they increase only about five- 
fold in 24 hours in milk kept at 50° F. 

The above enumeration includes most of the prin- 
ciples, the observation of which is absolutely neces- 
sary in the production of milk suitable for baby feed- 
ing. The source of supply should be investigated by 




COVERED MILK PAILS, SHOWING STRAINER IN PLACE 

Sixty-three per cent of the dirt that would fall in an open pail kept out 

by the cover 













^„,. 




-/f >"---', 




^•.'^LjdlSW* »' "'■ ■'■<- 


'-.., •'•*4#> 


ft-i'*'". , 




■ ^'^J^fi'- ' "' . 


, -'^^ 


^P:i^- 



COVERED MILK PAILS, SHOWING COVERS REMOVED 

Storrs Agricultural Experiment Station, Storrs, Connecticut 



ARTIFICIAL FEEDING 



87 



personal visit if possible. Some dairies in the larger 
cities furnish milk especially for babies, called ''certi- 
fied milk," at advanced price — 12 to 14 cents a quart. 
It will be found economy to pay the advanced price 
necessary for the extra care, but it may be well to 
make sure that the extra care is given. 

The cold sealed bottle when received at home must 
be placed at once in a clean refrigerator (free from 
taint or odor of other food or vegetables), and kept 
stoppered. The refrigerator should be kept at least as 
low as 50° F. This point should be tested with a 
thermometer. 

Milk received in good 
condition is not infre- 
quently rendered unfit 
for infants' food by 
careless handling in the 
home, 
which 



The bacteria 
by their growth 
render the milk unsafe 
are present everywhere 
— in the air with dust, 
in every particle of dirt, 
in water, on the hands and clothes, on all utensils and 
vessels. (vS'^^ Household Bacteriology.) No utensil, 
spoon or receptacle should be used which has not been 
sterilized. Aiilk once poured out should never be re- 
turned to the bottle, nor should remnants ever be used. 
Flies (common carriers of infections) must be reli- 
giously excluded. 




THE FREEMAN PASTEURIZER. 



Home 
Care of 
Milk 



CARE OF CHILDREN 



Treatment Where doubt exists as to the safety of the milk, or 
Milk during hot weather, it may be freed from germs by 
pasteurization or sterilization. The first is accom- 
plished by subjecting the milk for 40 minutes to a 
Pasteurizing temperature of 150° F. A pasteurizer is on the 
market in which the bottles of milk are placed and 
sufficient boiling water added to bring the temperature 
of the whole to 150° F.* In the absence of a spe- 
cial pasteurizing apparatus, a small jar or cup about 
the height of a nursing bottle is filled with boiling 
water. Into this the bottle containing one feeding of 
milk is immersed, the projecting neck stoppered with 
sterilized unabsorbent cotton. The whole is then cov- 
ered with a cozy or another jar to retard radiation 
and allowed to stand 40 minutes. The temperature 
should be tested in an extra bottle with a thermometer 
until the correct amount of boiling water to be added 
is determined. 

If preferred, the entire day's supply m.ay be pas- 
teurized at once, either in bulk or, better, in a number 
. of separate feeding bottles, which should then be 
cooled rapidly and kept on ice until used. It is im- 
portant to cool the milk as soon as possible, for the 
spores not killed by pasteurizing will develop if the 
milk is kept warm for some time. The quickest way 
to do this is to place the bottles in running water. 

sterilizing Sterilization, i. e., the destruction of both bacteria 

and spores, is accomplished by heating the milk to a 



* The Freeman Pasteurizer. Price, $3.50. 



ARTIFICIAL FEEDING 



89 



temperature of 212° F. (boiling temperature) for 
about an hour. This may be done in an ordinary 
double boiler or farina kettle. Thus treated the milk 
will keep unchanged for 24 hours or so. If necessary 
to protect it for a longer period, as for traveling, ship- 
ping, etc., the process must be twice repeated after 
intervals of 24 hours each, when, if properly sealed, it 
will remain bacteria free indefinitely. 




THE ARNOLD STEAM STERILIZING AND PASTEURIZING 
APPARATUS. Price, $3.00 to $5.00. 

It must be borne in mind that no amount of pasteur- 
ization or sterilization can make bad milk good. It 
merely destroys the bacteria, which by their growth 
render the milk unfit for infant food. The chemical 
changes in the milk which, through age, has begun to 
deteriorate, are beyond retrieve. 

Milk should be at first hand, like Caesar's wife, 
"above suspicion," in which case pasteurization is un- 
necessary and sterilization is unwise, as the high tem- 
perature changes it somewhat and renders it more 



Milk 
Must Be 
Fresh 



90 



CARE OF CHILDREN 



Supply 

Most 

Important 



difficult of digestion. A child fed continuously on 
cooked or sterilized milk is liable to develop nutri- 
tional disorders, as scurvy, etc. 

The practice of keeping the baby's food warm for 
emergencies is entirely wrong, as it favors the devel- 
opment of any bacteria present and spores which are 
not destroyed by pasteurization. 

Because of the limited field of operation of the 
milk laboratory home modification is of great impor- 
tance in artificial feeding. In this connection, the 
protection of the supply zvill ever continue to he the 
most important consideration. 

MODIFIED MILK 



Apparatus 

and 

Supplies 



To modify milk, satisfactorily in the home the 
mother or nur^se must be equipped with all necessary 
utensils. These include a good ice box, two syphcns 
(made by heating and bending, glass tubing), a ster- 
ilizer or pasteurizer thermometer registering to 212° 
F., a dozen graduated feeding tubes (large mouth 
without shoulder with small lip), bottle brushes, ab- 
sorbent cotton, straining gauze, non-absorbent cotton 
for stoppers, mixing pitcher, 8-ounce graduate, tall 
cup for warming bottle, three to six black rubber 
nipples (to fit mouth of tubes, reversible for clean- 
ing), bicarbonate of soda and boric acid. 

Lime water should be kept in well-corked bottles, 
as it is soon changed by the carbon dioxide in the air 
to carbonate of lime, which is deposited on the sides 



MODIFIED MILK 



91 



of the bottle. Milk sugar solution should be prepared 
fresh for each day's supply. 

The supply of food may be prepared once or twice 
in the twenty-four hours, depending upon the time of 
milk delivery and number of tubes to be used. The 
milk should always be kept on ice before and after 
preparation. 

All bottles and utensils should 

be washed with hot soapsuds, 
then rinsed and boiled or steril- 
ized. Nipples must be scrubbed 
inside and out wath soap and 
water, rinsed and kept in a solu- 
tion of soda or boric acid until 
needed again. Milk tubes when 
filled should be stoppered with 
non-absorbent cotton so that in 
cooling the air may pass 
through. After warming to 
about 100° F. (38° C.) by 
standing the bottle in a cup of 
warm water the cotton is re- 
placed by the nipple. 

After nursing, any food remaining in the bottle 
must be thrown away. No flies should ever touch 
food, utensils or baby. 

Of course, the nurse will never touch the nipple 
with her lips. The temperature of the milk may be 
tested by allowing a few drops to fall upon the back of 
the hand. Eternal vigilance is the price of sterility. 




AN EIGHT OUNCE 
GRADUATE. 



Time of 
Preparation 



"Warming 



92 



CARE OF CHILDREN 



Feeding The bottlc should be held inverted in the hand dur- 
ing the feeding so that the babe will not suck air. 
If the milk flow is too free the nipple may be with- 
drawn from time to time so that about twenty minutes 
is consumed in the feeding, during which the babe 




APPARATUS AND MATERIALS FOR MODIFYING MILK. 
Walker -Gordon Co. 



Follow 
Nature 



would better be on the arm or lap of the nurse. If the 
milk does not drop freely enough more holes should be 
made in the nipple by means of a hot needle. 

The rules of feeding as to regularity, number and 
length of intervals should be about the same as those 
given for infants at the breast. Water between feed- 
ings is generally required, and to a ravenous infant 
should be freely given. The water should be boiled 
and cooled and may be given from either bottle or 
spoon. 



MODIFIED MILK 93 

As a rule, artificial feeding in the normal vigorous Composition 
babies should be begun with formulae representing 
low percentages. Especially is this true of the pro- 




FEEDING THE BABY, 
Showing Proper Position of Infant. 

teids. Taking average mother's milk as a standard, 
the percentage of sugar may be about the same, the 
fats about half, and the proteids about one-third, 
for the first weeks, remembering that temporary error 



Proteids 

Low at 

First 



94 



CARE OF CHILDREN 



on the side of underfeeding is easier of correction 
than the more common mistake of overfeeding. 

The proteid in cow's milk is the most frequent 
cause of indigestion, and this absolutely essential in- 
gredient requires most careful watching. Since its 
variation by ever so little is sufficient, at times, to 
determine results, it would appear to be the point 
around which the problem of milk feeding revolves. 




HYGEIA PASTEURIZER AND STERILIZER. 



Increase 

Strength 

Slowly 



Hence the importance of the percentage method, both 
on account of its advantages for comparisons and in 
its ready adaptability to the necessity for slight 
changes. 

As toleration of the new diet is established a grad- 
ual increase may be made in the low constituents 
week by week until the ratio of ingredients approaches 
the standard of breast milk. The standard formulae 
given later should be used only as a suggestive guide 
and not as an imperative rule, since the first test of 
any food formula is its eifect upon the baby. 



MODIFIED MILK 



95 



In considering increase in the amount of food, we 
tnust be governed by age, size for age, stomach ca- 
pacity for age and the infant's hunger, but largely by 
the daily weight gain which should be manifest from 
week to week. 

The increase in the amount of 
food, like that af the percentage 
of its constituents should never 
he made suddenly. An ounce 
added to the total day's food in 
early infancy means an increase 
of from 6 to 3 per cent. This one 
ounce increase should be distrib- 
uted among the different tubes, 
i. e., if there are ten tubes, about 
one-tenth of an ounce should be 
added to each. If tolerated for 
several days another advance 
may be made in quantity. Four 
consecutive weeks should be the 
outside limit for an increase of an ounce at a feed- 
ing, as the tendency will be to far exceed the infant's 
stomach capacity by flooding him with a too diluted 
food. (See "Capacity of the Stomach," page 46.) 
Both the amount at a feeding and the strength should 
not be increased at the same time. 

The acid reaction of cow's milk renders the addi- 
tion of an alkali necessary. For this purpose bicar- 
bonate of sodium (baking soda) or lime water may 



Increase 
Amount 
Gradually 




THE HYGEIA NURS- 
ING BOTTLE. 



Neutralizing: 
Acidity 



96 



CARE OF CHILDREN 



be used (preferably the latter, of which 5 to 10 per 
cent may be necessary). The lime water also has 

the important property of 
making the curds more floc- 
culent and therefore more 
easily digested. Of the so- 
dium bicarbonate, one or two 
grains to the ounce will be 
sufficient. A solution of one 
drachm of sodium bicarbon- 
ate in a quart of water has 
the same alkaline strength as 
lime water. 

If the food is to be steril- 
ized, sodium bicarbonate 
should be used or the lime 
water should be added to the 
tube afterwards. Heating 
with lime water brings about certain undesirable 
changes in the milk. 

The following formulae fairly express the com- 
position, amount and frequency of feeding, with the 
length of intervals, for normal, healthy infants of 
average weight and development: 




FOOD WARMER AND 
ALCOHOL LAMP. 



MODIFIED MILK 



97 



Formula 1. 

Proteids; 22% Fats; l."00% Sugar; 6.50% 

Cream — (16%) \ ounce 

First 3 days Milk sugar \ " 

or Lime water _ | " 

Premature. Boiled water 7 '" 

Salt small pinch 

Total 8 ounces 

Feedings, 10 to 12; Quantity of each, i to ^ ounce; Inter- 
vals, 2 hrs. 



1st iveek. 



Feedings, 10; 
2 hrs. 



Formula 2. 

Proteids;. 0.47% Fats; 1.00% Sugar; 6 75% 

Cream — (16%) 1 ounce 

Skimmed milk 1 " 

Milk sugar 1 " 

L/ime water 1 " 

Boiled water 13 

Salt a pinch 

Total 16 ounces 
Quantity of each, ^ to 2 ounces; Intervals, 



Formula 3. 

Proteids; 0.58% Fats; 1.50% Sugar; 6 50% 

Cream — (16%) 1^ ounces 

Skimmed milk If " 

2nd week ^^^^ ^^^^^ ^^ " 

^nawee/c. i^ime water 1^ " 

Boiled water 20 " 

Salt 2 pinches 

Total 24^ ounces 

Feedings, 10; Quantity of each, 1 to 2 ounces; Intervals, 
2 hrs. 



98 



CARE OF CHILDREN 



3rd week. 



Feeding-s, 10; 
2hrs. 



Formula 4. 

Proteids; 0.70% Fats; 2 00% Sugar; 6.50% 

Cream — (16%) 4 ounces 

Skimmed milk 2 " 

Milk sug-ar IJ *' 

Lime water . . / 2 *' 

Boiled water 24 " 

Salt 2 pinches 

Total 32 ounces 

Quantity of each, 2 to 3 ounces; Intervals, 



Formula 5. 

. Proteids; 0.92% Fats; 3.00%, Sugar; 6.00% 

Cream — (16%) 6 ounces 

Skimmed milk 2 " 

4th & 5th Milk sugar 1^ " 

weeks. lyime water •. . . 2 " 

Boiled water 22 '* 

Salt 2 pinches 

Total 32'ounces 

Feedings, 10; Quantity of each, 2 to 3 ounces; Intervals, 
2hrs. 



6th, 7th, 8th 

. weeks. 



Feedings, 9; 
2J hrs. 



Formula 6. 

Proteids; 1.15% Fats; 3.00% Sugar; 6.00% 

Cream — (16%) 6 ounces 

Skimmed milk 3 " 

Milk sugar 1^ ** 

Lime water 2 '* 

Boiled water 21 " 

Salt 2 pinches 

Total 32 ounces 
Quantity of each, 3 to 3^ ounces; Intervals, 



3rd month. 



Feedings, 8: 
3hrs. 



MODIFIED MILK 99 

Formula 7. 

Proteids; 1.40% Fats; 3 50% Sugar; 6.25% 

Cream — (16%) 7 ounces 

Skimmed milk 4 " 

Milk sugar 1^ " 

L/ime water 2 ** 

Boiled water 19 " 

Salt 2 pinches 

Total 32 ounces 
Quantity of each, 3 to 4 ounces; Intervals, 



4th & 5th 
months. 



Feedings, 7; 



Formula 8. 

Proteids; 1.50%, Fats; 3.50%o Sugar; 6.75% 

Cream — (16%) 7^ ounces 

Skimmed milk 5| '* 

Milk sugar 2 ** 

L/ime water 2J " 

Boiled water 21 " 

Salt 2 pinches 

Total 36^ ounces 
Quantity of each, 4 to 5|; Intervals, 3 hrs. 



Formula 9. 

Proteids; 1.90% Fats; 4.00% Sugar; 7.00% 

Cream — (16%) 10 ounces 

Skimmed milk . . 10 " 

6th, 7th, 8th Milk sugar 2 ** 

months. Lime water 2^ " 

Boiled water ^ 18 *' 

Salt 2 pinches 

Total 40^ ounces 

Feedings, 6; Quantity of each, 6 to 7 ounces; Intervals, 
3 hrs, 

LOf C, 



100 CARE OF CHILDREN 

Formula 10. 

Proteids; 2.40% Fats; 4.00% Sugar; 6.00% 

Cream— (16%) 10 ounces 

Skimmed milk 15 *' 

9th & 10th Milk sugar IJ ♦' 

months. Lime water 2| " 

Boiled water 12| " 

Salt 1 pinch 

Total 40 ounces 

Feedings, 5; Quantity of each, 7 to 8 ounces; Intervals, 
3^ hrs. 

Formula 11. 

Proteids; 2.90% Fats; 4.00% Sugar; 6 00% 

Cream — (16%) 12 ounces. 

Skimmed milk 2 4 " 

nth month. Milk sugar ^ ;« 

I^ime water • . . . 3 " 

Boiled water 9 *' 

Salt 1 pinch 

Total 48 ounces 

Feedings, 5; Quantity of each, 7 to 9 ounces; Intervals, 
3^ hrs. 

Formula 12. 

Proteids; 3.40% Fats; 4.00% Sugar; 5.50% 

Cream — (16%) 12 ounces 

Skimmed milk . . 30 " 

l£th month. Milk sugar f " 

Lime water 3 ** , 

Boiled water 3 *' 

Total 48 ounces 

Feedings, 5; Quantity of each, 8 to 10 ounces; Intervals, 
4 hrs. 



MODIFIED MILK loi 

Formula 13 

Proteids; 4.00% Fats; 4.00% Sug-ar; 5.50% 

Whole milk 48 ounces 

ISth month. Milk sug-ar f ounce 

Bicarbonate of soda 30 grains 

Total 48 ounces 

Feedings, 5; Quantity, 8 to 10 ounces; Intervals, 4 hrs. 



These formulae are intended only as a suggestive 
guide in the feeding of normal infants according to 
ages specified. Delicate babies, or those of impaired 
digestion, should be given the formula for younger 
infants. 

These mixtures may be prepared from i6 per cent 
cream, skimmed milk, milk sugar, salt, lime water 
and boiled water. 

Six ounces of i6 per cent cream may be obtained 
from a quart bottle of good milk which has stood un- 
disturbed for six hours by siphoning away the lower 
four-fifths. This i6 per cent cream may also be 
obtained from a reliable dairyman. 

Milk sugar may be bought from the druggist by 
the pound, or more cheaply at wholesale in five-pound 
packages. 

Accurate scales not being available in most house- 
holds, the milk sugar must be measured. As different 
brands vary a little in weight for bulk, it is always 
advisable to have the druggist weigh accurately por- 
tions of one, one and one-half, and two ounces, which 
may be kept as standards. One of the most convenient 



Formulae 
for Normal 
Infants Only 



Sixteen 
Per Cent 
Cream 



Measuring 
Milk Sugar 



t62 CARE OF CHILDREN 

and accurate ways of measuring the amount for a 
formula is to put the required weighed portion into 
the graduate, tap a few times, and mark the level by 
scratching the glass with a file. This mark will show 
the amount to be. used each time the formula is made 
up. 

Tablespoons vary so greatly in size that it is not safe 
to use them for measuring the sugar. Two and one- 
half large size tablespoons Leveled with a knife will 
measure about an ounce, but if an ordinary kitchen 
tablespoon is used, it may take three and one-half 
leveled to give an ounce. As the milk sugar is the 
largest constituent of the baby's food, it is necessary 
that it be measured accurately. 

Milk sugar is used because it is more easily digested 
than cane sugar, and is not so liable to fermentation. 
Although only about one-half as sweet to the taste, 
it has about the same nutritive value as cane sugar. 
In the later months of the first year cane sugar may 
be substituted for milk sugar, if economy demands it, 
a smaller amount being used. 

Salt is added to promote digestion and to make up 
the deficiency occasioned by dilution. 
Milk Milk containing 4 per cent of fat should be used 

Should be . . . . , , . 

Anaiized in the formulae given. A good milk will have this 
amount, but the legal standard in many localities is 
3 per cent or less, so that it is best to have the milk 
supply analyzed occasionally. The board of health 
or the milk commission in many cities will make an- 



Modified milk 



io3 



alyses free, and in the country the dairies will per- 
form the same service for a small charge. If there is 
4 per cent of fats present, it is safe to conclude that 
the proteids are up to standard. 

For making up a formula the following directions 
may not be amiss : As soon as the baby's special 
bottle of milk is delivered to the house, it should 
be taken in and placed in the coldest part of the re- 
frigerator. H it is delivered very early in the morn- 
ing (during hot weather), a small ice box should be 
provided in which the milkman may place the bottle. 

In the country, if the milk is received while warm, 
it should be strained through absorbent cotton or 
cheesecloth into a clean quart milk bottle or preserve 
jar, stoppered, and placed in cold running water for 
about half an hour, and then put on ice for six hours, 
or until the cream has risen. 

It will be found convenient to keep the vessels, lime 
water, milk sugar, etc., together on a tray. The one 
to do the mixing should wash her hands carefully and 
put on a clean apron. The mixing should be done in 
a clean place. A copy of the formula to be made 
up should be at hand. 

To siphon off the milk, a glass tube should be used, 
as shown in the illustration."^ To start the siphon, fill 
it full of boiling water by pouring water in, place the 
thumb over the end of the long arm and invert the 
siphon, lowering the short arm gently to the bottom of 
the bottle of milk. Remove the thumb and the milk will 



Directions 
for Mixing: 



Siphoning 
Off the 
Skimmed 
Milk 



* A milk syphon may be obtained through the school for 25 cents. 



104 CARE OF CHILDREN 

follow the water out of the tube. It is best caught 
in another bottle or a 32-ounce graduate. A mark on 
the receiving bottle showing when 26 ounces have been 
drawn will leave the 6 ounces of 16 per cent cream 
in the first bottle, provided the bottles are full quarts 
of 32 ounces. If the milk is very rich in cream, less 
than 26 ounces of skimmed milk should be removed. 
Making Supposc Formula 4 is to be made up — the 6 oz. of 

Formula i6 per cent cream is first mixed to a uniform consist- 
ency by rotating the bottle gently ; exactly 4 oz. is 
measured in the graduate and poured into the mixing 
pitcher. Two ounces of the skimnicd milk is then 
very carefully measured in the graduate and poured 
into the pitcher. Two ounces of lime water is now 
measured and added to the pitcher; the i^ oz. of 
milk sugar is measured in the 8 oz. graduate as de- 
scribed, and the two pinches of salt added. Boiled water 
is added up to the 8 oz. mark. The mixture is stirred 
with a clean spoon kept for the purpose until the 
sugar is dissolved and added to the pitcher. Sixteen 
ounces of water (making 24 oz. in all) is measured 
and added to the pitcher and the whole is stirred with 
the spoon until thoroughly mixed. 

If wide-mouthed tubes are used, they may be filled 
by pouring directly from the pitcher up to the 2 oz., 
2^ oz. or 3 oz. marks on the tubes, according to the 
amount to be given at a feeding. If small-mouthed 
tubes are used, a glass funnel will be necessary. The 
tubes are stoppered at once with sterilized, non-absor- 



MODIFIED MILK 



105 



bent cotton, which is kept in some receptacle away 
from the dust. After stoppering the tubes are placed 
in a rack and put in the coldest part of the refrigera- 
tor. The whole operation should be accomplished as 



Keep the 

Milk 

Cool 




SIPHONING SKIMMED MILK FROM THE CREAM. 

If there is a difference in level of about 4^ inches between the two milk 

bottles, the siphon will stop running with approximately 6 

oz. of cream left in the upper bottle, and 26 oz. of 

skimmed milk in the receiving bottle. 

quickly as possible, so that the milk will not have 
time to become warm. It should be borne in mind 
that there is always dust laden with bacteria in the air 
of the cleanest room. The bacteria we are endeavor- 
ing to exclude. 

All the utensils used should now be rinsed first in 
cold water, then washed in hot soap and water, put 



Washing 
Vessels 



io6 CARE OF CHILDREM 

into a pan of boiling water for lO or 15 minutes, and 
then inverted. They should not be wiped with a 
towel, and if washed perfectly clean with plenty of 
soap will drain clear. The tray should be washed, 
and after the utensils are drained, they should be 
placed on the tray and covered with a cloth to keep 
out dust. The milk sugar should be kept stoppered. 

It is apparent that an ignorant, untrained servant 

cannot be trusted to carry out all these precautions, 

and that the mixing should be done by the mother or 

trained nurse. 

Change The importance of increasing the strength as well 

Formula as the quantity of the food gradually should again be 

to the Next , . . x i . t r . , 

emphasized. In changing from one formula to the 
next stronger, the simplest method of making the 
transition a gradual one is to add water to the new 
formula in such proportion as to reduce the percent- 
age of proteid to nearly that of the preceding formula. 
The following may serve as a suggestive guide: 

In changing from Formula 2 to Formula 3, add to the full 
quantity of formula 3, the first day 5 oz. of water, second day 
4 oz., third day 2 oz., fourth day I oz. 

Changing from Formula 3 to Formula 4, add 6 oz, of water 
the first day, 4 oz. the second day, 2 oz. the third day. 

Changing from Formula 4 to Formula 5, add 5 oz. of water 
the first day, 4 oz. the second, 3 oz. the third, 2 oz. the fourth, 
and I oz. the fifth. 

Changing from Formula 5 to Formula 6, add 8 oz. the first 
day, and i oz. less during succeeding days. 



MODIFIED MILK 107 

Changing from Formula 6 to Formula 7, add 7 oz. of water 
the first day, and i oz. less every two days. 

Changing from Formula 7 to Formula 8, add 25^ oz. of 
water the first day, 2 oz. the second day, i oz. the third and 
fourth days. 

Changing from Formula 8 to Formula 9, add 10 oz. of 
water the first day, and i oz. less during succeeding days. 

Changing from Formula 9 to Formula 10, add 10 oz. of 
water the first day and i oz. less during succeeding days. 

Changing from Formula 10 to Formula 11, add 9 oz. of 
water the first day and i oz. less during succeeding days. 

Changing from Formula 11 to Formula 12, add 5 oz. of 
water the first day and i oz. less during succeeding days 

Changing from Formula 12 to Formula 13, add 8 oz. of 
water the first day and i oz. less during each succeeding day. 

In case the new formula does not seem to agree, the 
number of ounces of water added should be reduced jf^tes 
more slowly. Carefully written notes should he kept 
of all changes. 

Cream containing 16 per cent of fat also contains 
a certain percentage of proteids and milk sugar. 
Roach gives the following composition: 

Composition of 16 Per Cent Cream 

Per Cent 

Water 76.7 

Proteids 3.2 

Fats 16.0 

Milk Sugar 4.05 

Composition of Skimmed Milk 

Per Cent 

Water 92 7 

Proteids 3.6 

Fats trace 

Milk Sugar 4.6 



Use of 
Whey 



Egff 
Altumen 



io8 CARE OF CHILDREN 

Where proteids are not tolerated whey (see recipe) 
may be substituted for the skimmed milk and for the 
whole or part of the boiled water. 

The whey contains the lac alburhen (but no casein), 
the sugar and the salts of the milk. The Walker- 
Gordon Co. gives the following analysis for the whey 
which they furnish. It is made from skimmed milk 
and contains practically no fat. 

Composition of Whey 

Per Cent. 

Water 93.6 

Proteids , i.o 

Milk Sugar 47 

Mineral Matter 0.7 

If the intolerance for milk proteids persists, the pro- 
teid of Qgg white (see recipe) may be substituted. 
The white of one egg has the proteid value of eight 
ounces of skimmed milk. 

Composition of White of Egg 

Per Cent. 

Water 857 

Proteids 12.6 

Fats 0.25 

Mineral Matter 0.59 



FOODS OTHER THAN MILK 109 

FOODS OTHER THAN MILK 

Other foods than milk may be utiHzed, to a limited 
extent, in the dietary of the infant. Of these there 
are three general classes. 

First : Farinaceous substances ; such as barley, oat- starch 
meal, arrowroot, farina, rice, wheat and bread, pref- 
erably in the form of water gruels, and jellies. 

Second: Albuminoids or proteids, of which class 
beef juice and ^gg white are the best representatives. 

Third: Fruit juices, as orange, prune and unfer- Fruit 

, Juices 

mented grape. 

The first class have, before the sixth month of in- 
fancy, but a limited food value, because of the indi- 
gestibility of their starchy contents. A partial con- 
version into sugar may be secured, however, by thor- 
ough and prolonged cooking, as in the preparation of 
gruels and jellies. A still further conversion may 
be secured by the addition of diatase, as malt and 
malt extracts, a few minutes before feeding. This 
changes a certain amount of the starch into dextrin. 

Cereal gruels, in some cases, promote digestion of Gruels 
cow's milk by mechanically preventing the formation 
of dense curds in the stomach. They may be used to 
replace all or a part of the water of a formula. 

When the proteid of cow's milk is not well borne 
that most essential constituent may be supplied from 
raw beef juice or egg white. (See recipes.) 

Orange juice, prune juice and unfermented grape 
juice are very valuable food adjuncts in cases of nutri- 



no 



.CARE OF CHILDREN 



Patent 
Baby 
Foods 



tional depravity. These are especially needed where 
the infant has been subject to the prolonged use of 
cooked and pasteurized foods. 

Many of the so-called baby foods contain little more 
than starch, and on that account can not be too 
severely condemned for young children ; but the prac- 
tice, somewhat in vogue, of denouncing all patent 
foods on that account is thoughtless and unjust. There 

Percentage Composition of Infant Foods 



Food 


Moisture 


Proteids 


Fat 


Carbo- 
hydrates 


Mineral 
Matter 


Remarks 


Horlick's 

Malted 

Milk 


3.9 


13 8 


3.0 


76.8 


2.7 


A mixture of desic- 
cated milk (50^) and 
malted wheat and bar- 
ley. N o unaltered 
starch. 


Mellin's 
Food* 


5.7 


10.7 


0.1 


79.1 


4.4 


A completely malt- 
ed food. All the carbo- 
hydrates in soluble 
form. 


Nestle's 
Food* 


3.6 


14.0 


5.2 


75.1 


1.9 


A mixture of desic- 
cated milk, partially 
malted wheat flour 
and cane sugar (27fc). 
Starch 15%. 


Eskay's 
Food* 


1.7 


6.7 


3.5 


87.1 


1.0 


A mixture of par- 
tially malted wheat, 
egg albumin and milk 
sugar (54^). Starch 
29^, especially treated. 


Condensec: 
Milk 


C2.0 


9.1 


10.7 


15.5 


4.3 


Unsweetened whole 
cow's milk. 1 part di- 
luted with 2 parts wa- 
ter gives ordinary 
milk. Sweetened con- 
densed milk contains 
about 37^ cane sugar. 


Dried 

Human 

Milk 




12.2 


26.4 


52.4 


2.1 


Analysis by 
Hutchison 



* Latest analyses, ({Iven by the manufacturers. 



MEDICAL SUPERVISION 



III 



is much to recommend in some of these preparations, 
since intelligent modification by supplying a deficiency, 
may convert it into a most valuable adjunct in sub- 
stitute feeding. Food which would not meet the re- 
quirements of nutrition for a long-continued period, 
because deficient in some essential constituent, may 
be used temporarily, as in weaning, traveling or tem- 
porary removal from the breast. 

Among the objections to many of the patent foods 
may be mentioned : small amount of fats ; insolu- 
bility of their proteids when present ; excess of sugar, 
especially cane sugar ; the high percentage of uncon- 
verted starch and the fact that all have been cooked. 

The writer believes that the artificially fed infant 
should always be under the supervision of a competent 
physician. Some one has said that it is twice as dan- 
gerous to be a baby as it is to have smallpox. The 
mortality in untreated typhoid is less than half that 
of artificially fed babies, yet no one questions the 
necessity for a physician in typhoid. Few regard the 
physician as out of place at the birth of the infant, 
yet the mortality during birth is slight compared with 
that of bottle feeding. The most active function of a 
physician's life is remedying errors, in attempting to 
patch up the evil results of mistakes. His highest 
function is to ward off the error and to prevent the 
mistakes. 

The infant at the breast is in normal relation with 
his most imperative need and is seldom under the 
physician's care. He who substitutes artificial for 



Medical 
Supervision 
in Artificial 
Feeding 



Bottle Fed 
Babies not 
in Normal 
Condition 



CARE OF CHILDREN 



No Perfect 

Substitute 

Food 



Province 
of the 
Mother 



natural feeding unnecessarily may be likened to the 
captain who, in a safe roadstead, slips his cable in 
the face of a gale and trusts his vessel to unknown 
waters without pilot, chart or compass. 

No method yet devised can take the place oi breast 
feeding. No substance nor combination has been dis- 
covered that meets all the requirements of the infant 
as does breast milk. 

The vast amount of study and research of the best 
minds have evolved as yet towards the solution of this 
question only a few scientific principles. The appli- 
cation of these to individual cases calls for the best 
work of the trained physician. 

As before said, the most available artificial food for 
babies, cow's milk, can not be made to resemble that 
of the mother, and in many instances man's highest 
skill can not adapt it to the requirements of the infant, 
though he modify it ever so wisely. How difficult, 
then, the task of writing formulae for the modifica- 
tion of an indefinite substance (milk) for the feeding 
of unknown infants, whose unknown requirements 
are the result of unknown conditions. 

The supervision of the physician does not lessen the 
care required of the mother or nurse, nor m.ake it less 
necessary that she should understand the situation. 
However wise the advice may be, trouble is almost 
sure to follow unless the rules and precautions given 
are followed to the letter. 



FOOD DISORDERS '' 113 

FOOD DISORDERS 

Overfeeding is responsible for many of the diges- Overfeeding 
tive disturbances of infancy. Among the causes of 
overfeeding may be mentioned irregularity as to time ; 
thirst ; perverted taste ; improperly balanced or too 
concentrated a food; too rapid feeding, and general 
ignorance or carelessness on the part of the nurse. 
The usual result of occasional overfeeding is acute 
indigestion, with or without vomiting, belching, colic, 
diarrhoea, curds in stool, restlessness, broken sleep, 
fever or loss of weight. 

Habitual overfeeding may cause dilatation of the 
stomach with loss of digestive power and all the symp- 
toms of chronic dyspepsia, such as flatulence," colic, 
constipation or diarrhoea, loss of weight or general 
mal-nutrition. 

Occasional colic or loose stools or even vomiting coiic 
may call for nothing more than a temporary diminu- 
tion of food and a dose of castor oil. In mild cases, 
the food may be diluted with about a fourth the vol- 
ume of water, either in the nursing bottle before feed- 
ing or when the day's supply is made up. The quan- 
tity given may also be reduced somewhat. In return- 
ing to the original formulae the change should always 
be made gradually. ' 

Persistent colic may be an indication of excessive 
proteids, the percentage of which should be reduced 
to the relief of both colic and diarrhoea, with the dis- 
appearance of curds from the stools. 

Vomiting, or "spitting up," with or without diar- vomiting 



ii'4 



CARE OF CHILDREN 



Hot 

"Weather 

Diet 



Do Not 
Experiment 



rhoea, may be caused by an excess of fat and yield 
promptly to a reduction of this constituent. If food 
is not digested fermentation occurs in the bowels, with 
the formation of poisons, which cause restlessness and 
fever.' This "auto-intoxication" is of frequent occur- 
rence in infancy, but is usually relieved by the cor- 
rection of the dietetic errors. 

A common mistake is the neglect to modify the 
food with due regard to the season. Hot weather re- 
quires diminution in the fats and proteids (from one- 
eighth to one-half), so that what constituted a well- 
balanced food for the winter months is not suitable 
for the heated term. In hot weather infants need 
more water and frequently cry from thirst rather than 
hunger, 

The long-continued use of food deficient i n fat 
is often productive of rickets. Scurvy may be de- 
veloped by the habitual use of cooked food, while 
mal-nutrition is the result of chronic indigestion. 

The prevention and correction of these disorders 
lies in proper feeding (See "Essentials.") Their 
symptoms will be discussed in the section on Chil- 
dren s Ailments. 

The practice of experimenting on the baby with all 
kinds of food — patent and otherwise — is a most per- 
nicious one. Nature takes some time to rectify diges- 
tive disturbances, and a slight improvement at each 
feeding is all that can be expected. If the simple 
changes suggested do not give relief after a day or 
two, the physician should be consulted. 



FOOD AFTER THE FIRST YEAR 



Bottle feeding is rarely necessary after the twelfth 
month. The child may be gradually taught to drink 
from a spoon or cup. Where the baby is delicate the 
bottle may be used until the fifteenth month. 

The eruption of teeth, the increase in the salivary, 
gastric and pancreatic secretions give not only greater 
power of starch and proteid digestion, but also the 
ability to masticate some solid food. 

Semi-solids must be introduced gradually into the 
dietary, milk remaining the principal food. Cream 
is required particularly where there is a tendency to 
constipation. Until the eighteenth month little 
change should be made except the addition of gruels,- 
meat broths and cracker or stale bread soaked in milk. 
Five feedings in the 24 hours during the second year 
are sufficient for a healthy child. 

The following dietary is intended only as a sugges- 
tive guide. Variety at this age is not necessary, but a 
choice is designated by the letters a, h, c. 

Dietary from 12 to 18 Months 
First ]\Ieal. 6 to 7 A. M. 

a — Glass of warm milk containing a little stale bread or 
rolled cracker. 

h — A porridge of well cooked (at least two hours) cereal 
with milk. 

c — A little soft tgg (poached or boiled) with stale bread 
crumbs and a glass of milk, 

115 



Taking 
Away the 
Bottle 



Semi- 
Solids 



ii6 CARE OF CHILDREN 

Second Meal, io A. M. 
Glass of warm milk. 
Third Meal, i to 2 P. M. 

a — Stale bread soaked in gi-avy from the roast or steak. 

Milk. 
b — Soft egg, a little zwieback, glass of milk. 
c — Toast soaked with beef juice (see recipe), glass of 

milk. 

Fourth Meal. 5 to 6 P. M. 

Glass of milk or milk with cereal jelly. (See recipe). 
Fifth Meal. (If necessary late in the evening or night.) 

Glass of warm milk. 

Dietary from the IStli to 24th Month. 

First Meal. 7 A. M. 

a — Warm milk with stale bread or buttered cracker. 
b — Cereal porridge with milk and cream. 
c — Glass of milk, soft boiled egg with bread and butter. 
Second Meal. 10 A. M. 
a — Bread and milk. 

b — Milk from oyster stew and cracker, 
r— Milk toast. 
Third Meal. 2 P. M. 

a — Mashed potatoes with dish gravy and a glass of milk 
b — Mutton, beet or chicken broth thickened with rice or 

barley, bread or cracker and milk. 
c — Beef juice on toast, rice or tapioca pudding. With 
this meal may be given a little well baked apple 
pulp or stewed prune pulp and juice. 
Fourth Meal. 5 to 6 P. M. 

Bread and milk, or bread with butter and milk. 
Milk may be given during the night if the baby seems 
hungry. 



FOOD AFTER THE FIRST YEAR ny 

Dietary for Third Year 

First Meal. 7 to 8 A. M. 

a — Cereal with plenty of milk and cream. 

b — Soft boiled or poached ^gg with toast and milk. 

c — Meat jelly with bread or cracker and milk. 

Second Meal, ii A. AI. 

Bread and milk, meat, or clam broth with cracker. 

Third Meal. 2 P. M. 

a — Broiled scraped beef with buttered baked potato. 

Milk. 
h — White meat of fish or fowl, mashed potato with bread 

and butter. 
c — A little finely cut steak or roast, creamed potato or 

boiled rice and milk. 
Light pudding, junket, stewed fruit or a little ice cream 

may be added to the above. 

Fourth AIeal. 6 to 7 P. ]\1. 

a — Bread and butter, glass of milk. 

h — Cornmeal mush and milk. 

c — Baked apple, graham crackers and milk. 

During this year the child should occasionally have pruit 
a little orange juice, scraped raw apple, grape pulp 
free from seeds, ripe banana grated fine, ripe peach 
or pear. 

After the third year the child is presumably sitting At the 
at the family table and will, if not well managed, in- Table 
sist upon having things not good for him. Many sys- 
tems are hopelessly impaired for want of parental tact 
and firmness at this time. If the child is once taught 
that he may not choose for himself, he will gladly 



Ii8 



CARE OF CHILDREN 



Foods 

Not 

Advisable 



Stimulants 



accept the food suitable to his age and condition. In 
planning the meals for a family containing several 
young children consideration should certainly be given 
to their requirements. 

The following articles are best avoided during early 
childhood : 

Condiments or highly sea- Cake. 

soned food. Hot breads. 

Pork. .Cucumbers. 

Fried meats. Corn. 

All fried foods. Doughnuts. 

Griddle cakes. . Doughey puddings. 

Cabbage. Rich puddings. 

Tomatoes. Over or under ripe fruits. 

Pastry. Raw celery.' 

Dumplings. Turnips. 

It goes without saying that children should never 
be allowed tea, coffee, beer or other stimulants. 

Nuts and confections should never be allowed on an 
empty stomach. 

General Rules 

I — Regularity as to meals is of prime importance. 
2 — Thorough mastication is absolutely essential to 

perfect digestion. 
3 — Rapid eating invariably induces dyspepsia. 
4 — Fluids are essential to good digestion, but the 

food should never be "washed dozvn/' 
5 — A judicious balance must always be maintained 

between the five food constituents, viz. : pro - 

teids, fats, sugar, salts and water. 



FOOD RECIPES 

Beef Juice 

Salt and slightly broil small pieces of thick, lean, 
round steak and while hot express the juice with a 
meat press or a lemon squeezer. The juice may be 
given cold or with the addition of a little warm water. 
Hot water coagulates the albumin. Made in this way 
the juice contains from 5 to 6 per cent of coagulatable 
proteids and from 2 to 3 per cent of "extractives" — 
nitrogenous substances without nutritive value, but 
stimulating to the digestive organs. 

Beef Tea 

To I pound of lean chopped or minced beef add i 
pint of cold water. Stir and let stand for 2 hours ; 
then let simmer for 20 minutes. Do not boil. Strain 
and when cool remove all fat. When ready to use 
warm and season. Best prepared in double boiler. 

Mutton Broth 

Over I pound of lean meat, cut in small pieces, 
pour I quart of cold water, let stand in cold place for 
3 hours, then cook slowly down to i pint. Cool, skim 
off fat, and strain. 

Veal, chicken or beef broths may be made in the 
same way. 

Meat Pulp 

By scraping with a dull knife separate the meat 
pulp from the fiber. Season pulp, make in small cake 
and slightly broil, or may be salted and eaten raw. 

119 



120 CARE OF CHILDREN 

Whey 

Heat I quart of fresh milk luke warm; into this 
gently stir 2 teaspoonfuls of Fairchild's essence of 
pepsin ; let stand about twenty minutes or until firmly 
coagulated, then with a fork break up the clot and 
strain through fine muslin without pressure. Bring 
the whey thus obtained to a boil to kill the ferment, 
then cool and keep on ice. 

Albumin Water 

Put the white of one egg in a saucer and cut (do 
not beat) until fine with knife and fork. Add i cup 
cold boiled water and strain through cheesecloth. 
Keep on ice until ready to use. If desired a tiny 
pinch of salt may be added. 

Lime Water 

Drop a piece of unslaked lime as large as a walnut 
into a vessel containing 2 quarts of pure filtered 
water, stir thoroughly and allow to settle. Pour off 
the clear solution into bottles, which should be kept 
corked. 

Oat Jelly 

Soak half a cup of coarse oatmeal in a quart of cold 
water for 10 hours. Boil down so as to make a pint 
and while hot strain through fine cheesecloth. A 
jelly is formed when cold. It should be kept on ice 
until needed. 

Wheat and rice jelly can be prepared in the same 
way. 



POOJD RECIPES 121 

Barley Water 

Put I tablespoonful of washed pearl barley in a 
saucepan with a quart of water; boil slowly down to 
I pint ; strain. 

Barley Jelly . 

Boil slowly down to a pint, i quart of water and 3 
tablespoonfuls of pearl barley; strain and let stand 
until jellied. 

Peptonized Milk 

In 4 ounces of boiled cold water, dissolve a tablet 
containing 15 grains of bicarbonate of soda and 5 
grains of pancreatine, to which add 12 ounces of milk. 
Set vessel containing this mixture in a pan of water 
at a temperature of ii5°F for from 8 to 10 minutes. 
Cool quickly by placing in running water and keep on 
ice until used. Use double boiler for making. To 
completely peptonize the milk heat for two hours. 
It then has a bitter taste. 

Dropped Egg 

Drop a fresh egg into enough boiling milk to cover ; 
remove from milk as soon as the white is set; salt 
and serve hot with cracker or bread crumbs. 

Dried Bread 

Cut bread at least 24 hours old in thick slices ; put 
in slow oven and bake until thoroughly dried. (20 to 
30 min.) 



122 CARE OF CHILDREN 

Kumyss — (Holt) 

I quart of fresh milk, half an ounce of sugar, 2 
ounces of water, a piece of yeast cake at least half 
an inch square; put into wired bottles, keep at a tem- 
perature between 60 and 70 F. for i week, shaking 
5 or 6 times a day ; put on ice. 



TEST QUESTIONS 

The following questions constitute the ''written reci- 
tation" which the regular members of the A. S. H. E. 
answer in writing and send in for the correction and 
comment of the instructor. They are intended to 
emphasize and fix in the memory the most important 
points in the lesson. 



CARE OF CHILDREN 

PART II 

Read Carefully, Place your name and address on the 
first sheet of the test. Use a light grade of paper and write 
on one side of the sheet only. Leave space between the 
answers for the notes of the instructor. Use your own 
words and answer fully. Read the lesson paper a number 
of times before attempting to answer the questions. 

1. What is the best food for the baby and why? 

2. What is the effect upon the child of too much 

fat in the milk? Too little? 

3. What are the indications for early weaning? 

4. Why should the baby not nurse the breast of a 

sleeping mother ? 

5. Give and explain four rules for nursing. 

6. Give in detail the difference between mother's 

and cow's milk. 

7. What may be done to increase the percentage 

of fat in breast milk? The percentage of 
proteid ? 

8. Give some of the causes of impairment of 

mother's milk. 

9. How should the baby be weaned? 

10. When the proteids of cow's milk are not toler- 

ated, what may be substituted for them? 

11. Why give a baby water? When? How? 

How much? 



CARE OF CHILDREN 

12. State general objections to the patent baby- 

foods. 

13. What is safe milk? How should the baby's 

milk be cared for in the home? 

14. What governs the quantity given at a feed- 

ing? The strength of the food? 

15. Give the causes and effects of over feeding. 

16. What are the principal dangers in feeding a 

baby cow's milk? 

17. What is meant by a balanced food? 

18. Why are special precautions necessary to keep 

the baby's food as nearly sterile as possible? 

19. What can you say in regard to feeding during 

the second year? 

20. How would you alter the food of a young baby 

in very hot weather? 

21. What may the mother or nurse safely do if 

the baby has indigestion? 

22. Mention new facts you have learned from this 

lesson. 

23. What questions have you to ask? 

Note. — After completing the test, sign your full name. 




JAN. FEB. nAR. APL. MAY JUN. JUL. AUG. SEP. OCT. NOV OtC 



CHILDREN UNDER I Yr. 

1-2 Yr. 

2-5 Yr. 
5-15 Yr. 
OVER 15 Yrs. 

CHART SHOWING MORTALITY IN LARGE CITIES BY MONTHS • 
AND AGES 
From Circular of Illinois State Board of Health on Infant Feeding 



CARE OF CHILDREN 

PART HI 

The Sick Child 



SYMPTOMS OF DISEASE 

The sick child should, of course, always be under 
the physician's care, but the mother can aid greatly 
by giving him an intelligent account of symptoms. The 
mother knows (or should know) her child much more 
thoroughly than can any outsider and it is on her 
carrying out of directions faithfully and intelligently 
that the recovery of the sick child must depend. 

In order to recognize the symptoms of disease it is symptoms 
necessary to become thoroughly familiar with the nor- 
mal, healthy infant. This is accomplished only by . 
careful, conscious observation. Attitude, both sleep- 
ing and waking; facial expression, movements of ex- 
tremities, trunk, head and eyes; sounds, both articu- 
late and inarticulate; respiration, frequency and regu- 
larity; color of the skin and condition as to tempera- 
ture and moisture, are all significant of sickness or 
health. 

Restlessness or apathy, if but slight, may be esti- 
mated only by comparison with the baby's normal con- 
dition. 

A few of the most easily recognized indications of 
acute disorder may be mentioned, such as sudden loss 
of appetite, excessive thirst, unusual drowsiness, lan- 
guor or fretfulness, all of which may indicate intoxi- 
cation, 

123 



124 



CARE OF CHILDREN 



Breathing 



Fever 



The screaming infant may give some hint as to 
the location of his pain by chewing his fingers when 
the mouth or throat is inflamed ; by carrying his hand 
to his head or pulling at his hair when the ear or 
mastoid region is the seat of trouble ; by writhing mo- 
tions of the body with drawing up of the knees which 
indicates abdominal pain, whether of the stomach or 
bowels or bladder. 

The rapid breathing may indicate pulmonary dis- 
order; the terminal expiratory moan, pneumonia; or 
the restricted, expiratory grunt may mean an abdomi- 
nal pain or pleurisy, the short suppressed cough end- 
ing in a cry may indicate pneumonia or pleurisy. 

Headache is often indicated by puckering of the 
eyebrows and intolerance of strong light, while throw- 
ing the head back with rigidty of the neck or continu- 
ous head rockmg are common symptoms of meningitis 
or brain fever. Twitching of the face or of the ex- 
tremities may be the precursor of convulsions. 

The flushed face of fever is too obvious to be over- 
looked and the whiteness about the lips and nose is 
always indicative of nausea or irritation of the intesti- 
nal tract, whether from indigestion or worms, and 
usually precedes vomiting. 

Crying when handled usually indicates some local 
tenderness in trunk or limbs and may be due to in- 
juries, such as dislocations, fractures or contusions ; 
or to the tenderness of rickets, scurvy, syphilis, rheu- 
matism or inflammation of some joint, Copious sweat- 



THE CRY I2S 

ing during sleep, especially about the head, is always 
suggestive of rachitic malnutrition. Disinclination or 
inability to move a limb should never be overlooked 
as it may mean a grave disorder, either in the affected 
limb or in the central nervous system. Refusal to 
nurse may be due to trouble in the mouth, throat or 
nose which parts should be frequently examined. 

THE CRY 

There is no such thing as a meaningless cry. It is 
only a question of interpretation. The cry is the in- 
fant's only means of making his wants known. 

Most welcome is the baby's first cry induced by the no 
discomfort of his new surroundings and its vigor and crylng'^^*^^ 
volume may indicate vital capacity. A little lusty cry- 
ing in the first days is good for the baby as thereby 
deep inspiration is induced which more fully inflates 
the lungs and establishes more completely the new 
function of respiration. Some babies never entirely 
overcome the adhesions of the bronchial tubes and air 
cells, a part of the lung remaining unused. 

The cry should be clear and distinct and any devi- 
ation from its normal tone is an indication of disorder. 
Whatever the cause of crying it is usually tearless be- 
fore the third month. 

Hunger is usually expressed by crying, but it is a Hungry 
great mistake to conclude that because the child was ^^^ 
quieted by the nipple he was therefore hungry. He 
may have been thirsty, or the warm milk may have 



126 



CARE OF CHILDREN 



Persistent 
Crying 



"Whining 



temporarily relieved the pain due to indigestion. In 
either case the food will harm him. Water was what 
he needed. 

Most often a baby cries because he is uncomforable 
— the diaper may need to be changed ; the clothes may 
need straightening out, he may need a change of posi- 
tion, or he may be cold. There is such a thing, too, 
as the crying habit, which over-anxious mothers help 
to establish by holding the baby, rocking, singing, 
walking, coddling or nursing at the first intimation of 
restlessness, however transient if left alone. 

A persistent cry, if not due to hunger or thirst, is 
indicative of pain, as from pin prick, itching from 
bites, eruption, eczema. Earache causes intense pain. 
Paroxysmal crying may mean colic or bowel cramps, 
and ceases when the gas moves. Usually with this 
pain the feet are drawn up and the belly is distended. 
Pleurisy or tenderness of rickets causes baby to cry 
when lifted by the arms or chest. Tenderness about 
legs . would suggest rheumatism or scurvy. 

Peevish whining indicates poor health and general 
discomfort. Brain inflammation is often indicated by 
a shrill piercing shriek uttered at long intervals. 
Short suppressed cry occurs in lung inflammation, es- 
pecially following coughing. Sudden screaming at 
night suggests night terrors or bad dreams. Hoarse 
croupy voice points to the larynx, and a nasal tone 
to stoppage of nose and upper .throat. Mouth dis- 
orders cause fretfulness and crying when anything is 



COLIC 127 

put into the mouth, while cry after swallowing sug- 
gests sore throat. 

The baby may cry when passing urine due to tight 
foreskin or the passage of brown uric acid sand, which 
may be found staining the diaper. If the child frowns 
while crying or fretting and avoids the strong light, 
headache is probably the cause. 

COLIC 

Colic is usually due to the pressure of gas in the Causes 
bowels, one of the results of indigestion. Sudden and 
violent crying, distended abdomen, alternate drawing 
up and straightening of the legs, which ceases with 
the expulsion of gas by mouth or anus, usually indi- 
cate colic. This colic is often due to too frequent or 
too copious feeding, hence the great mistake in quiet- 
ing the cries of the colicky baby by more feeding. 
Some babies are especially prone to colic and must be 
fed with extreme care. 

Again babies are colicky while showing no other 
evidence of dietetic error. In these cases the attacks 
may be due to chilling of the surface of extremities. 
Great care, therefore, is necessary in maintaining 
proper warmth by suitable clothing, especially of the 
hands and feet. (See baby bag, page 22.) 

Another form of colic is caused, as before men- xrric Acid 
cioned, by sharp uric acid crystals in the kidneys and ^°^^° 
urinary tubes. 

Simply changing the position, as holding the baby 
over the shoulder, is often effective in expelling the 



128 ^ CARE OF CHILDREN 

Treatment gas. Gentle massage of the abdomen is helpful. Hot 
carminative teas, as peppermint, anise, camomile and 
catnip, with a grain or two of bicarbonate of sodium, 
may relieve the pain, or in case of exhaustion as in- 
dicated by cold or blueness, 2 or 3 drops of brandy 
in a little water sweetened with milk sugar may be 
added. Dry heat applied to the extremities and abdo- 
men by means of hot flannel or water bag with gentle 




RUBBER CATHATER. 



massage of the abdomen will assist. A warm high 
enema or a rubber tube (see Medicine Chest) intro- 
duced and left in the bowel for a few seconds may 
promote the expulsion of the gas. Where colic is per-' 
sistent or of frequent occurrence the physician should 
be consulted with regard to a change in the diet. 

CONSTIPATION 

Constipation is so common during infancy that some 
physicians have regarded it as normal to that period 
of life. While not agreeing with that opinion, it is 
apparent that certain anatomical and physiological 



CONSTIPATION I2g 

peculiarities of the infant's intestinal tract predispose 
to constipation. 

O'ccasonally it may be relieved by the giving of Water 
water between feedings. As one of the functions of cream 
fat in the food is to promote bowel movements much 
good may result from the administration of a little 
cream, properly diluted, after nursing, or by the in- 
crease of this element in the baby's bottle, if he is 
artificially fed. For the same purpose a few drops 
of olive or cod liver oil, which babies take readily, 
may be given after each meal. Care must be taken 
not to develop fatty diarrhea or stomach intolerance 
with up spitting or vomiting as a result of fat indi- 
gestion. 

For older infants and children molasses taffy given Massage 
after food has a laxative effect and much benefit may 
be derived from fresh fruits and fruit juices given 
regularly when tolerated. 

At all ages daily gentle massage of the abdomen 
to stimulate the peristoltic action of the intestine 
should never be neglected with children having a tend- 
ency to constipation. To be most effective the abdo- 
men should be stroked and kneaded gently and firmly, 
following the course of the large intestine, namely, up- 
wards on the right side, across above the navel and 
downwards on the left side towards the groin. 

Where the food is concentrated and quickly ab- coarse 
sorbed, constipation calls for coarser and more bulky 
food so that older children should be given coarsely 



130 CARE OF CHILDREN 

ground cereals, as cracked wheat, corn bread, graham 
bread, also fruits, as grapes with the seeds, figs and 
stewed prunes. 
Drugs The frequent use of drugs for constipation should 
be discouraged and should rarely be resorted to ex- 




HARD RUBBER INFANT SYRINGE 

cept by the advice of the family physician. In obsti- 
nate cases the bowels may be relieved by an occasional 
enema of soapy water or sweet oil. 
Regularity Regularity is most important. As stated on page 
40 this may be taught to infants at an early age with, 
perhaps, the assistance of a "suggester" in the form 
of a piece of soap whittled to a point. With older 
children a fixed time (preferably after the breakfast) 
for daily defecation should be established. Thus, and 
by attention to the diet, any tendency to constipation 
may be overcome and many grave disorders of later 
life obviated. 

STJMMER DIARRHEAS 

Summer diarrheas are most prevalent and fatal 
during the periods of infancy and early childhood, 
the greatest susceptibility to this disease being found 
between the ages of six and eighteen months, which 
time the death-rate is many times that at any other 



DIARRHEAS 



131 



age, hence mother's well-known dread of the baby's 
second summer. 

In children of all ages a transient form may occur 
at any season, with decided predilection, however, for 
the heated term. In midwinter occasional attacks of 
severe, although usually transcient, diarrhea without 
fatal tendency are seen, but it is in the summer months 
that intestinal disorders, with diarrhea as a common 
symptom, are most fatal. The high rate of mortality 
among infants and children during the summer months, 
resulting from disorders of which diarrhea is an ac- 
companiment, exceeds that of all other diseases dur- 




Mortality 



BULB INFANT SYRINGE 



ing the same period. Nearly 90 per cent of the deaths 
from this cause are among artificially fed babies. 

The immediate cause of summer diarrhea is thought 
to be the presence of great numbers of certain bacte- 
ria found in unclean and improperly cared for milk. 

The onset is sometimes sudden, being ushered in by 
a convulsion, vomiting and diarrhea. There is usually 
high temperature, thirst and nausea which makes the 
infant snatch at food but push it quickly aside as soon 
as a few mouthfuls have been swallowed. Restlessness 



Onset of 
Diarrhea 



132 



CARE OF CHILDREN 



Vomltingr 



Drain of 
Fluids 



is nearly always present. The stools may change sud- 
denly or may be two or three days in changing from 
the normal in frequency and character. There may be 
a great deal of colicky pain. 

The infant while apparently in perfect health may 
develop vomiting, the matter ejected being at first the 
contents of the stomach but little changed — highly acid 
or in dense curds ; this is soon followed, however, by 
a watery, slimy and rarely by a biled-stained fluid, less 
acid or even alkaline in reaction. Diarrhea frequently 
accompanies and invariably follows the onset of the 
disturbance. The first stools may be nearly normal 
but they quickly change, showing evidence of fermen- 
tation and later on putrefaction. Finally they becom.e 
watery and may be of a brownish or greenish color. 
The odor of the stool varies from the normal sour 
to intensely putrid and later to a sickening musty 
smell. 

The infant, apparently well nourished and playful, 
quickly shows signs of systemic disturbance in fretful, 
peevish irritability and restlessness, with head rocking, 
anxious facial expression, persistent whining cry, 
fever, dry mouth and softened flabby tissues. The 
depressed fontanel, sunken, lusterless eyes, sharply de- 
fined temples, drawn features with the intense thirst 
all give evidence of the great drain of fluids. The 
abdomen, at first distended with gas, may soon be- 
come flabby and depressed and the extremities cold, 
although the rectal temperature may be from 103° to 



DIARRHEAS 



i33 



106° F. Convulsions may usher in the attack, follow 
the initial vomiting by a few hours, appear only at the 
final stage or occasionally they may not develop. 
Within twenty- four hours from the onset, and fre- 
quently earlier, the stage of collapse is reached, with 
pallor and coldness of the surface, though the internal 
temperature may be high. The restlessness soon sub- 
sides into stupor with shallow breathing, collapsed 
veins, failure of pulse, half closed filmy eyes and death 
occurs in convulsions or from exhaustion. 

This picture presents symptoms of acute poisoning 
from the stomach or intestinal tract occurring in a 
state of apparent health and terminating fatally in from 
twenty-four to forty-eight hours. 

Though the well-nourished infant is not exempt 
from this form of acute poisoning it occurs with much 
greater frequency among those who show evidence of 
malnutrition. 

Acute summer diarrhea is frequently but improperly 
called cholera infantum. Fortunately the true cholera 
infantum (caused by a specific germ) with its almost 
invariably fatal termination is by no means common. 

The commonest form of summer diarrhea is the re- 
sult of acute indigestion usually caused by improper 
or impure food or overfeeding. Not infrequently 
these attacks of vomiting and diarrhea are relieved by 
the giving of one or more doses of castor oil and the 
withdrawal of food for twenty-four hours. In such 
cases the diet should be resumed very gradually, be- 



Acute 
Poisoning 



Cholera 
Infantum 



Mild 
Cases 



Effects 



134 CARE OF CHILDREN 

ginning with small quantities of white of egg water, 
barley water, strained broth or weak malted milk. 
After A prolonged attack of summer complaint rarely 
leaves the child free from evidence of retarded devel- 
opment, which in many instances is never fully com- 
pensated. Perhaps the most important effect of severe 
summer complaint upon the survivors is the feeble 
resistance to infection from . lowered vitality, so that 
the danger from contagious diseases is greatly in- 
creased. 

It is needless to say that the mother's immediate 
duty is to summon her physician upon the appearance 
of the first symptom of summer diarrheas. 

ABNORMAL PASSAGES 

The normal passages of the infant have been de- 
scribed on page yy, and various abnormal stools have 
been mentioned in connection with other disorders, 
but it may be well to summarize here. Like vomiting, 
any divergence from the normal in the appearance of 
the stool is a sign of warning. They should be kept 
for the inspection of the physician. 

Stools may be abnormal in frequency, consistency, 
color and odor. During the suckling period the baby's 
stools may vary in frequency from one to six daily 
without apparent departure from health, the average 
probably being three movements in the twenty-four 
hours. 

Variations in the quantity and quality of food in- 



ABNORMAL PASSAGES 



135 



gested may cause variations in the quantity and fre- 
quency of the discharges which, if normal in color and 
consistency, need occasion no anxiety. 

Breast or exclusive milk feeding gives a light color 
to the evacuations, varying from a canary to a cream. 
As before stated, the normal consistency of the suck- 



Color 




JOINTLESS BULB SYRINGE. 



ling's stool is about that of thin batter and is smooth 
and homogeneous throughout. But little gas is pres- 
ent and the normal odor when freshly voided is 
slightly sour and not especially offensive. 

If cereals, starch, sugar or proprietary foods enter 
largely into the dietary the stools will .be darker, rang- 
ing from orange to brown with a greater tendency to 
gas formation and a disagreeable odor. 

Stools are abnormal when they have a putrid odor 
suggestive of decomposition ; when they are bubbly 
or yeasty, suggestive of fermentation; when they are 
watery or contain blood or mucus; when they are 



Odor 



136 CARE OF CHILDREN 

heterogeneous in character; when they are acrid and 
irritate the anus and skin of the buttocks; when they 
are green or variegated in color or gray and tough or 
putty Hke; when they are hard and lumpy like mar- 
bles coated with slime or when they are dry and 
crumbly, either dark brown, pale gray or white. ^ 
Mucus Mucus is normally present in the discharges, but it 
is only when irritation of some part of the mucous 
membrane of the digestive tract has caused an extra 
abundant flow that it becomes visible. Curds in the 
passages indicate incomplete digestion, the causes of 
which are many and sometimes hard to determine. 
The quantity of food may be too great, or it may be 
too strong, it may be taken too rapidly, too often, too 
cold, there may have been chilling of the baby or too 
much excitement, and so on. 

Although some of these conditions may be remedied 
by the judicious use of castor oil and slight changes in 
diet, or manner of feeding, they all suggest the advice 
of the physician, before the underlying causes lead to 
disorders which may become obstinate. 

RICKETS MALNUTRITION AND SCURVY 

Rickets (rachitis). Malnutrition (marasmus) and 
Scurvy (scorbutus) are essentially nutritional disor- 
ders, and as such depend both for their treatment and 
cure largely upon proper feeding. 

The rickety child shows a constitutional perversion 
of development which, if not arrested, may lead to ac- 



RICKETS 



137 



tual deformities. There is lessened resistance to dis- 
orders of an infectious nature, hence a marked tend- 
ency to catarrhal conditions of all the mucous tracts. 
Early deaths from acute diseases are frequently due 
to the feeble resistance of the rickety constitution. 
Rickets is oftenest seen in children between the ages 
of six months and four years, though some of its 
effects are visible throughout life. 

Three groups of symptoms and signs stand out pre- 
eminently as rachitic. ■ 

First. The nervous system shows instability; there 
is fretfulness, irritability and intellectual precocity. 
Tendency to spasmodic seizures is sometimes marked. 
A form of general spasm, known as "tetany" being 
peculiar to the rachitic infant. So, also, the crowing 
spasms so frequently mistaken for croup are essen- 
tially rachitic. The bright, fidgety child who runs on 
his toes and the head-sweating, restless, cover kicking, 
sleep moaning infant suggest the same rachitic disturb- 
ance of nerve function. 

Second. The muscular system shows tardy devel- 
opment in strength and remains flabby, so that the in- 
fant is late in learning to stand or walk and does not 
sit erect. Curvatures of the spine frequently show the 
inefficiency of the muscles to support the trunk. The 
child, meanwhile, may appear to the uninformed as 
w^ell nourished; in fact, may be fat or overfat with 
pin-cushiony pads on the top of his feet and the back 
of his hands. His inability to stand is frequently at- 
tributed to his great weight. 



Nervous 
Symptoms 



Muscular 
Development 



Indications 



138 CARE OF CHILDREN 

Bony Third. This group consists of signs induced by the 

pecuHar retardation of bone growth, such as late clos- 
ure of the fontanel, square shaped skull, with lateral 
ridges and bulging forehead, very late and irregular 
dentition, enlargements at the ends of the long bones 
showing prominently above the wrist joint and at the 
ends of the ribs where they join the cartileges of the 
breast bone. These nodules extend from the upper 
part of the chest in two receding lines downward and 
outward like an inverted V and from their resemblance 
to beads are known as the rachitic rosary. The bones 
of the rachitic are slow in hardening^ hence their 
ready bending under weight, or pressure resulting in 
bow legs or knock knees. The chest, too, in later life 
shows permanent deformities and the ''pigeon breast" 
IS a lasting witness to a rachitic infancy. Babies fed 
on good breast milk very rarely show rickets. 

Successful treatment depends upon the recognition 
of the earliest rachitic symptoms in their incipiency, 
namely, those of the first group. The physician should 
be consulted early, as too often this condition is neg- 
lected until the third group or bony changes are well 
under way. 

Rachitic infants often show large abdomen with 
narrow chest and a marked flaring of the lower border 
of the ribs. They are especially prone to digestive 
and respiratory disorders and frequently show signs 
of tenderness about the chest and trunk when lifted. 



MALNUTRITION 



139 



Since a paucity of fat in the food is largely responsi- 
ble for this disorder that constituent should be freely, 
though judiciously, supplied, while the inert starchy 
constituents and the excessive fattening and gas form- 
ing sugars should be reduced. Meanwhile the physi- 
cian may endeavor to secure a better supply of earthy 
salts for the deficient bone forming constituents. 

Marasmus is a special term applied to that general 
form of malnutrition which seems to be seated upon 
an inherited or inherent vice of nutrition. It goes 
without saying that if the feeding of a normal baby 
requires judgment that of the marantic infant will ex- 
ercise the highest skill of the ablest physician. ''Weakly 
from birth" is the common expression applied to these 
babies whose death could be ascribed to no definite 
disease. Of course, malnutrition may result from mal- 
hygiene in what would otherwise prove to be a nor- 
mal infant, and rachitis, one of the results, not only 
of improper feeding but also of bad environment as 
to pure air, sunlight and warmth, plays no small part 
in the production of marasmus. 

No one may prescribe the exact line of feeding or 
treatment for an unseen case of malnutrition. Since 
no two marantic children present the same specific 
disturbances. There is usually the extreme emacia- 
tion which gives the infant the appearance of senility. 
The rheumy lack luster eye, the weazened face, feeble 
wail and voracious hunger, presents a vivid picture of 
starvation, while the large abd6men and frequent foul 



Malnutrition 



Feeding 



140 CARE OF CHILDREN 

smelling stools with or without vomiting emphasizes 
the need of most careful feeding. How to do this is 
the special problem for the doctor in each individual 
case. That any intercurrent infection should speedily 
terminate the existence of the marantic infant is not 
surprising. 
Scurvy Scorbutus is a disease occurring only in infants fed 
continuously on cooked food and is never seen in the 
baby fed exclusively at the breast. The modern tend- 
ency or fad for artificial baby foods and sterilized milk 
is largely responsible for the increasing frequency of 
this disorder in recent years. 

Scorbutus is so eminently a food disorder that no 
treatment is necessary other than the proper change 
in diet. The earliest symptom is crying when the in- 
fant is handled as in bathing, changing, dressing, etc., 
and the nurse may discover that it is the legs, espe- 
cially the thighs, that are tender to the touch. Some- 
times a swelling is observed about the inner or back, 
part of the thigh, above the knee, with a red or blue 
discoloration as from a bruise. Frequently the swell- 
ing is marked and the limb so tender that rheumatism 
is suspected. Black and blue spots are occasionally 
seen on different parts of the body or limbs, the re- 
sult of ordinary handling. The absence of fever (the 
temperature is usually subnormal) excludes rheuma- 
tism and ordinary inflammations. Later the skin shows 
purple spots due to "blood settling," and sometimes 
bright red spots, the size of a pin head, under the 
skin as though a little artery had leaked. 



COLDS 



141 



The baby takes nourishment poorly, and may have 
indigestion with diarrhea. The inside of the mouth 
is dark red, the swollen, spongy gums bleed readily 
upon pressure. Occasionally blood is vomited which 
had previously been swallowed from the mouth. Later 
still, hemorrhages may occur from any mucous tract 
and the stools show blood in clots like liver or changed 
to the appearance of coffee grounds. Without relief 
death soon follows. 

For treatment cooked food must be replaced by 
something raw. A teaspoonful of orange juice, di- 
luted, may be given 5 or 6 times a day. Raw milk 
properly modified, raw beef juice; the white of tgg 
will, if not too late in its administration, bring about 
a remarkable change. 



Treatment 



COLDS 



Ordinary colds are the infections from the ever 
present micro-organisms which cause catarrhal in- 
flammation of some mucous tract when normal resist- 
ance is lessened. Lessened resistance may be due to 
lowered temperature from exposure, from over fa- 
tigue, excitement, loss of sleep, mal-nutrition or indi- 
gestion. Also from over-feeding, occasional or ha- 
bitual. Impure air, also, lowers vitality and invites 
infection. 

Acute catarrh (acute cold) may affect the mucous 
membrane of the nose (Rhinitis) ; mouth (Stomati- 



No Germs 
No Colds 



142 



CARE OF CHILDREN 



Common 
Cold 



tis) ; the middle ear (Otitis) ; the eyes (Conjuncti- 
vitis) ; the pharynx (Pharyngitis) ; tonsils (Tonsilli- 
tis) ; larynx (Laryngitis) ; bronchial tubes (Bron- 
chitis) ; stomach (Gastritis) ; bov/els (Enteritis) ; 
large bowel (Colititis or Dysentery) ; bladder (Cys- 
titis) ; or the genitals (Urethritis, Vaginitis or Vul- 
vitis). 

Catarrh rarely is confined to a single area but shows 
a tendency to extend along the continuous mucous lin- 
ing to adjacent tracts. Repeated acute attacks tend 
to become chronic under neglect and low vitality. The 
secretions or discharges from any catarrhal tract will 
positively infect another which is susceptible, hence 
their prevalence and the term "common cold." N'o 
cold is trivial. All colds, with discharges, are con- 
tagious. 



Frequent 
Symptom 



SORE THROAT 

Sore throat is always due to infection, and though 
it may prove trivial it should never be so regarded, 
as it is frequently the forerunner of a most grave dis- 
ease. No physician ever fails to examine the throat 
of a sick child, and the mother should always do so. 
The tonsils are very commonly the seat of disease 
from which infection readily gains access to the blood 
and system. Recurrent attacks of acute tonsillitis re- 
sult in permanent enlargement of these structures with 
increased tendency to acute attacks, and absorption of 
poison which causes enlargement of the neck glands. 



SORE THROAT 



143 



The throat may become nearly closed, breathing in- 
terfered with, voice is changed and relief is found only 
m removal of the tonsil by the surgeon. 

The space above the tonsils, behind the soft palate 
and at the top of the pharynx, is most important. It 
may well be called the anarchist's den, for here hidden 



Anarchist's 
Den 



. / \_,^-'Ha|))i.M,f jrtLiK 



;^ \ rost»'iir»r 

latitH' arch 




'-^^w^m^' 



DIAGRAM OF THE MOUTH. 

The "Anarchist's Den" is above the "Pharyngeal Isthmus' 



from sight more dangerous infections are cultivated 
than in any other part of the body. It is called the 
"post nasal space." Into it open from in front the 
passages from the nose ; from the sides, the tubes from 



Adenoids 



144 



CARE OF CHILDREN 



the middle ears; and from below, the upper end of 
the pharynx. It is warm, moist, dark and ventilated, 
an ideal place for the growth of micro-organisms 
which find in the catarrhal secretions of its mucous 
lining their ideal food. All nasal catarrhs extend to 
this space, and the hawking and spitting is due to ac- 
cumulations here. 

Repeated attacks of catarrh (cold in the head) 
cause soft warty growths, called Adenoids, or "the 




AN OIL ATOMIZER 



Care of 
the Nose 



third tonsil," which sometimes fill this space, blocking 
the ear tubes, causing ear disease and deafness, shut- 
ting off the air and forcing the child to breathe 
through the mouth with snoring in sleep. These 
adenoids give to the voice a nasal tone, change the 
shape of the face, raise the roof of the mouth which 
gives the child a stupid expression and ultimately af- 
fects both mind and body. The only cure when well 
advanced is in removal by the surgeon. 

The early habitual care of the nose, naso-pharynx 
and throat by sprays and washes will do much to pre- 



CROUP 



145 



vent the numerous ills due to the neglect of this im- 
portant area. 

With a child subject to colds, the oil atomizer should 
be used daily, night and morning. Alboline with some 




GIVING A NASAL DOUGH. 

medication such as menthol will be prescribed by a 
physician. The formula may need to be weakened at 
first by adding plain alboline until the child becomes 
accustomed to the treatment 



Oil 
Atomizer 



CROUP 



There are two forms of croup, spasmodic and diph- 
theritic. The first form occurs usually at night. The 
child may or may not have shown signs of illness be- 
fore going to sleep. Frequently he has been troubled 



Kinds 
of Croup 



146 CARE OF CHILDREN 

with a cold and some hoarseness during the day. Sud- 
denly he is awakened with a barking, metallic (croupy) 
cough and may sit up struggling for breath. He may 
have noisy inspirations with all the symptoms of im- 
pending suffocation. The doctor is hurriedly sum- 
moned, but ere his arrival the paroxysm has passed and 
the child is sleeping with little evidence of disturb- 
ance, or the attack may recur three or four times in 
the night. Usually the second night sees a return, 
although he has spent the day comfortably. A return 
on the third night is not uncommon but with lessened 
severity. Children rarely die in these attacks, as tlie 
suffocation relieves the spasm of the larynx, allowing 
the air to enter freely again. Some children are 
''croupy" while others are exempt. Cold and damp- 
ness are the usual exciting causes. The attacks are 
commonest from 2 to 3 years and are rarely seen after 
the sixth year. 
Emetic For croupy children an emetic (see Medicine Chest) 

for Croup . . . 

should be kept in the house and a dose administered 
before sending for the doctor. 

Diphtheritic croup is laryngeal diphtheria, one of 
the diseases most to be dreaded. It may complicate 
a previously existing diphtheria of the throat or nose 
or the disease may make its first appearance in the 
larynx. The symptoms are continuous and increasing 
air hunger with great restlessness and weakness. A 
physician should always have the case in charge vv^ith 
the assistance of a trained and experienced nurse. 



TEMPERATURE 



147 



TEMPERATURE 

Elevation of temperature in infants and children 
may be due to slight causes but should never be dis- 
regarded. Fever is an indication for rest and careful 
watching, and in an acute attack food should be re- 
duced or entirely withheld. 



Cause 
May Be 
Slight 




TAKING TEMPERATURE BY RECTUM. 

Fever due to indigestion from over or improper 
feeding is not uncommon, while on the other hand in- 
sufficient food may cause elevation of temperature 
known as "inanition fever." When due to indiges- 
tion, fever may be relieved by removing the offending 
material by means of a brisk cathartic (castor oil), or 
copious enema, or both. Inanition fever calls for 
nourishment. 

A daily rise in temperature of from 2 to 4 degrees 
long continued, especially in the evening, is suggestive 
of tuberculosis. 

A continued fever or a daily rise in temperature de- 
mands medical advice. Feverish conditions may be 
greatly allayed by tepid sponging or the cool bath. 



Sponging: 



NERVOUS DISORDERS 



Exciting 
Causes 



Symptoms of 
Nervousness 



An excitabk condition called nervousness is usually 
due to unbalanced nutrition or insufficient rest. In- 
heritance may exert an influence as a remote or pre- 
disposing cause and the "nervous temperament" has 
long been recognized. 

Among the exciting causes may be mentioned fa- 
tigue, indigestion, foreign bodies in the digestive tract, 
as v^orms ; local irritations which by reflex action dis- 
turb nerve equilibrium, as disorders of the genitals, 
irritable bladder, constipation, seat worms ; inflamma- 
tion of the middle ear ; growths in the naso-pharynx ; 
eye strain ; skin eruption as eczema, etc. Also im- 
proper clothing which occasions unequal temperature 
or discomfort. 

Some of the manifestations afe seen m disturbed 
sleep, grinding of teeth, bad dreams, night terrors, 
muscular twitchings, chorea (Saint Vitus's dance), 
convulsions or epilepsy. 

Some of the minor symptoms appear as fidgeting, 
squirming, grimacing, blinking, chewing, nail biting, 
head scratching, picking at the nose, bed wetting and 
ready crymg, which to the experienced eye proclaim 
some nerve irritation. 

Children should rarely be punished but rather fed 
for the correction of these involuntary manifestations 
of nervousness. The wise parent will always consult 
the physician in these cases. 

148 



NERVOUS DISORDERS I49 

CONVULSIONS, SPASMS, FITS, CRAMPS 

In the category of infantile disorders nothing is 
more dreaded and no childhood ailment demands great- 
er presence of mind on the part of the mother. It has 
frequently been stated that children rarely die of 
spasms, that is, the convulsion of itself rarely kills. 
Spasms do not constitute the disease, but are only 
symptoms of some disorder which disturbs the 
equilibrium of the nervous system. 

We have seen that reHex action was highly devel- cause of 
oped at birth and that inhibition (control) was a func- 
tion of later development. The younger the infant 
the greater the likelihood of muscular contractions 
being excited beyond control of the feeble inhibition. 
Therefore anything which powerfully excites mus- 
cular contraction may induce convulsions in infants 
and young children. 

Hyper-excitability and feeble inhibition are also to 
a certain extent hereditary. The so-called nervous 
constitution finds its best expression in this want of 
balance between excitability and inhibition. Nutri- 
tion also plays an important part in determining the 
balance between these two functions of the nervous 
system (see Rickets). What might be a very trifling 
disturbance in the adult may induce convulsions in 
the infant. Again spasms may be one of the symp- 
toms of a very grave disease. It is the cause of the 
fits, then, that is of paramount importance. 



ISO CARE OF CHILDREN 

From the above may be seen some of the reasons 
why spasms are frequently among the terminal symp- 
toms of a fatal disease, so that death, not of but in 
convulsions, is not infrequent in young infants. 

Among the various causes are the onset of some 
severe illness as scarlet fever, pneumonia, brain dis- 
ease, etc., or convulsions may be induced by indiges- 
tion, constipation, intestinal worms, high fever, very 
hot weather, severe pain or fright. The ordinary chill 
in the adult may be expressed by a spasm in the infant. 
Symptoms The symptoms of a spasm may be so slight as almost 
to escape notice, such as transient eye squint, turning 
in of the thumbs or great toe, slight muscular twitch- 
ings of the face or jerking of the trunk muscles. 
These evidences of so-called "internal spasms" may 
pass away or may prove the beginning of violent con- 
vulsions, hence should not be disregarded. 

General convulsions involve nearly all the muscles 
of the head, trunk and limbs. Usually there is a pe- 
culiar choking sound in the throat; the twitching fea- 
tures become set ; the eyes fixed and staring, crossed or 
rolled upwards, showing only the whites, the body be- 
comes rigid with the back arched, the hands clenched 
and arms flexed, the jaws firmly closed and if teeth 
be present the tongue is usually bitten. The face be- 
comes blue from suspended respiration. 

This rigidity usually lasts but a few seconds and the 
child begins to jerk violently with rhythmic motions 
in arms, legs and trunk. An unnatural audible sound 



CONVULSIONS 151 

sometimes occurs with the breathing and the free flow 
of saliva may be churned into a froth which clings to 
the lip. The jerking then becomes less marked and 
finally ceases and the child soon recovers consciousness 
and cries or falls asleep from exhaustion. This cycle 
is usually completed in from one to three minutes, 
though to the watching parents it may seem many 
times that. 

The attacks may recur at intervals for many hours 
if the cause is not removed and death has been known 
to occur apparently from exhaustion. 

Since in infancy one of the commonest causes of Treatment 
convulsions is indigestion or the presence of some irri- 
tant in the digestive tract the first thing to be done is 
to clean out the stomach and bowels. A prompt 
emetic should be given at once, followed by a dose of 
castor oil. A copious enema of warm salt solution 
(teaspoonful of salt to a pint of warm water) should 
also be given. 

For the relief of the immediate spasm the child 
should be quickly immersed in a hot bath (temperature 
110° F. or test with the whole arm) containing a tea- 
spoonful of strong mustard to the gallon, with ice cold 
cloths to the head. A simpler method of applying 
moist heat is to wrap the baby in a small blanket or 
turkish towel wrung out of hot water. 

A physician should be at once summoned, but if he 
is not in reach and the convulsions recur an enema of 
fiwt grain tablet of sodium bromide dissolved in an 



152 



CARE OF CHILDREN 



After 
Effects 



ounce of tepid water may be administered and retained 
by pressure upon the anus, or half this dose may be 
given by mouth to a child of i8 months, every two 
hours if necessary. 




A NIGHT LIGHT. 

Although as stated, death is rarely due to a convul- 
sive seizure, it is none the less to be dreaded, and all 
means should be employed to ward off its recurrence, 
for the reason that severe spasms, from whatever 
cause, may result in permanent injury to the delicate 
tissues of the brain, among the results of which may 
be paralysis, with mental impairment, 



CONTAGIOUS DISEASES 

Contagious diseases are those due to germs carried f°fl^^^^^ 
to the individual from some other person suffering 
from that disease. These germs may come through 
direct contact or may be brought by air, water, food, 
clothing, books, papers, letters, etc., so that the source 
from which the child is exposed is often difficult to 
trace. 

Of the contagious diseases we will consider only 
those most commonly found in infancy and childhood, 
viz., measles, scarlet fever, chicken-pox, diphtheria 
and whooping cough. They have a common resem- 
blance in that they have a stage of incubation (the 
interval from exposure to the first symptoms), all are 
self limiting diseases (run out their course), all are 
accompanied by more or less fever, one attack usually 
immunes from a second (except in diphtheria), each 
has the characteristic skin eruptions (except diph- 
theria and whooping cough), and each has its stage of 
invasion (the interval between the first symptoms and 
the appearance of the characteristic symptom). 

MEASLES 

Measles, German measles, scarlet fever and chicken- Eruptive 
pox are called the "eruptive fevers." 

Measles is the most frequent and most contagious^ 
attacking all ages and is most prevalent in the winter 
season. It is contagious during stages of incubation, 
probably from the breath of the patient, and is rarely 
carried by a third person. Though lightly regarded 

153 



Fevers 



154 CARE OF CHILDREN 

by most people, measles is a very serious disease, espe- 
cially in delicate children, where it may prove fatal 
from the broncho-pneumonia or tuberculosis which 
frequently follows it. 
Symptoms The attack bes^ins with the symptoms of a bad cold ; 

of Measles - - 

eyes red, nose wet, fever, hoarseness, sneezing and 
cough, with slight sore throat, coated tongue and fe- 
verish breath. About the fourth day the rash appears, 
first on the face, gradually spreading downward over 
the trunk and limbs, which it usually covers in twenty- 
four hours. This consists of dusky red, slightly ele- 
vated, flattened papules, from wheat grain to split pea 
in size. On the face and trunk, especially, they run 
together, giving a blotchy look to the dark red with 
little spaces of normal skin between. The rash period 
is less than a week and fades away gradually. 

The eyes may be very troublesome and permanent im- 
pairment often follows. The cough may increase with 
symptoms of pneumonia. The fever, in uncompli- 
cated cases, subsides with the rash, which is followed 
by a falling off of fine branny scales continuing dur- 
ing the week of convalescence. Treatment: Call a 
doctor, avoid bright light and put child to bed in a 
warm room. 

GERMAN MEASLES (ROETHELN) 

A milder disease than measles, for which it is fre- 
quently mistaken. It generally comes in epidemic 
form in the winter season. The rash appears on the 
second day, first on the face in pale rose spots slightly 



SCARLET rEVER 155 

elevated, size of pin head, which usually reiiiain sepa- 
rate. When they do run together they do not form 
blotches like measles but rather a continuous redness 
like scarlet fever, for which it is sometimes mistaken. 
The rash spreads downward rapidly over the body, 
at the same time beginning to fade from the face so 
that in three days it has disappeared. The fever is 
slight, with a little sore throat and wet eyes and nose. 
Usually small scales from the outer skin fall off a few 
days after the rash. 

Treatment: Protect from broncho-pneumonia by 
keeping in bed on light diet. 

SCARLET FEVER (SCARLETINA) 

Scarlet fever is very common at all ages above six 
months. Occurs most frequently in Autumn (after 
schools open) and is very contagious. The germs 
may be carried in clothing and may live for a year 
stowed away in clothes and bedding. 

The disease may be so mild as to be overlooked or virulence 
so severe as to destroy life in 24 hours. The mildest 
case may furnish germs for one of the severest type, 
hence the importance of recognizing and isolating 
every case. It usually comes on suddenly with vomit- 
ing. High fever appears on the first day and rash on 
the second. Eruption first appears on the neck and 
spreads rapidly over the body and Hmbs but usually 
spares the face. The color is uniformly scarlet in typ- 
ical cases with pm points of intense red showing 
through. The throat is red and sore from the begin- 



156 CARE OF CHILDREN 

ning of invasion and may develop a whitish membrane 
Hke diphtheria. The tongue, at first white coated 
with red points showing through, cleans off so that by 
the third or fourth day it has the glistening red rasp- 
berry appearance, called "strawberry tongue." 
Duration The fever lasts a week or ten days, the rash from 
five to eight days. A mild attack may suddenly de- 
velop alarming symptoms and may be followed by 
ear disease, enlarged glands of the neck, rheumatism, 
heart disease or Bright's disease. The latter after 2 
or 3 weeks. Treatment: Isolate the child and send 
for the doctor. 

CHICKEN POX (VARICELLA) 

Chicken pox is very common. Limited to no age, 
and may be carried by a third person. Onset mild. 
F/equently the first symptom is the eruption of small 
rose colored spots on neck and trunk, which change in 
a few hours to little blisters about the size of a split 
pea or larger, filled with water. These stand out 
prominently, having a narrow red ring around their 
base. There may be a thousand or only ten at one 
time on the entire body. The blisters dry down and 
scab, and another crop appears so that spots, blisters 
and scabs may all be present at once. 

About a week terminates the eruption and the child 
gets well. Scabs should not be picked off, as pock 
marks will result. Large blisters on the face should 
be pricked and treated by the physician to prevent 
pitting. 



DIPHTHERIA 157 

DIPHTHERIA 

Before the use of antitoxin this was an extremely 
fatal and is even now a dread disease. No age is ex- 
empt, though it is rarely seen in very young infants. 
It is most prevalent in damp weather when sore 
throats are common and may develop in any sore 
throat or catarrhal nose or larynx. In the latter sit- 
uation it is known as "diphtheritic croup," a most dan- 
gerous form, for, added to the blood infection we have 
the danger of suffocation from laryngeal obstruction. 
In this complication it is often necessary to introduce 
a tube that the child may get air. 

The germs of diphtheria may be carried long dis- 
tances and maintain their infective properties for 
months. Hence the utmost care must be observed to 
isolate the child and destroy all secretions from throat 
and nose. One attack does not prevent, but rather 
favors, subsequent infection. 

The stage of invasion is marked by feverishness, loss symptoms 
of appetite, debility and sore throat. The reddened 
throat may show one or more whitish patches on one 
or both tonsils. Next day both tonsils and soft palate 
may be covered with a thick, greyish white membrane 
which may invade the naso-pharynx and cause dis- 
charge from the nose. The breath is fetid and the 
glands under the angle of the jaws may swell enor- 
mously. No disease of brief duration causes such 
muscular weakness as diphtheria, and some cases of 
death from heart failure occur after the child is over 
the disease itself. 



IS8 



CARE OF CHILDREN 



Treatment: Prompt and strict isolation and most 
rigid observance of the physician's orders. The acute 
stage of this disease rarely lasts more than a week. 

WHOOPING COTJGH 

Most commonly seen in young children and infants. 
It is highly contagious and is seen at all seasons of the 
year. It usually comes through direct exposure. The 
mistaken idea that whooping cough is not a dangerous 
disease has cost many lives. 
Onset The onset is gradual, the stage of invasion lasting 
from one to three weeks as a mild bronchitis before 
the characteristic whoop is heard. Some children do 
not whoop, which is merely the effect of forcible in- 
spiration after a prolonged paroxysm of coughing. 
In that case the nature of the affection must be deter- 
mined by the paroxysmal character of the cough, 
which recurs after intervals of one to three hours, and 
usually ends in gagging and spitting up sticky phlegm 
from the throat, or vomiting the contents of the stom- 
ach without nausea. 

Between paroxysms the child may appear in usual 
health and spirits. The cough is worse at night. 
Much food is lost in vomiting and nutrition suffers. 
The younger the child the more dangerous the disease. 
Duration Whooping cough covcrs about two months. A 
longer continuance is usually due to the bronchitis 
which complicates it. The complication may be se- 
vere and sometimes fatal in infants. Lowered nutri- 
tion is quite serious, and feeding should follow rather 



FOREIGN BODIES 159 

than precede the paroxysm to secure retention of the 
food which must be liquid for prompt absorption. 

Treatment: Broncho-pneumonia and tuberculosis 
are important sequelae. The best of medical super- 
vision is due in each case but probably nothing is more 
important than abundance of fresh air. 

FOREIGN BODIES 

The swallowing of foreign bodies that are not poi- Bulky 
sonous need cause no alarm or special anxiety, as the 
bowel will usually discharge the body in a few days. 
Its passage may be facilitated and the stomach and 
bowels protected from injury by copious feeding with 
mush and milk or bread stuffs. As sometimes the ob- 
ject lodges in the narrowing portion of the oesophagus 
near its upper end, from which it may be recovered by 
means of curved forceps, the physician should be con- 
sulted, or an X ray examination had to determine its 
location. If the child be choked by a foreign body in 
the throat, suspension head downward with slapping 
on the back may cause its ejection. 

In the Ear. A foreign body in the ear which can xjse of 
not be dislodged by syringing the ear with warm water Synnge 
should be sent to the physician. The body itself is 
harmless if no clumsy attempts at extraction be made. 

An insect in the ear should be drowned in sweet oil 
and later washed out with a syringe. 

In the Nose. A body in the nose that can not be 
dislodged by blowing the nose or by sneezing should 
be sent at once to the specialist, as unskilled attempts 
at removal are usually mischievous. 



i6o CARE OF CHILDREN 

EARACHE 

Earache may be the first intimation of an inflamma- 
tion of the middle ear. The screaming infant may 
sometimes pull his hair or put his hand to the affected 
side of the head. Gentle pressure with the thumb in 
front of or behind the ear may cause flinching from 
tenderness. After pus has formed its pressure will 
usually rupture the drum rnembrane and allow a dis- 
charge through the external passage. Inflammation of 
the middle ear is usually due to infection from the 
throat or naso-pharynx through the tube (eustachian) 
which connects the two cavities. Acute congestion of 



EUBBER EAR SYRINGE. 

the ear with intense pain is sometimes the result of ex- 
posure to cold or drafts and may be relieved by hot 
applications as salt or water bag. The infected ear 
may be gently filled with hot water or warm sweet 
oil, care being taken not to burn. 
Danger of ^^ great harm results from neglected ear trouble 
Meningitis ^^^^ ^j^g |^gg^ mcdical advicc should be obtained upon 
the appearance of the first symptoms. Aside from 
pain and danger of impaired hearing from formation 
of pus in the middle ear it should be remembered that 



EARACHE i6i 

this cavity is in close relation to that containing the 
brain, and frequent death in infants and children from 
brain fever (meningitis) is the direct result of infec- 
tion by this route. 

The relation of meningitis in children to the neglect- 
ed nose, throat and ear, is a very intimate one. 

The following table shows briefly a few of the typical Table of 
points of resemblance and difference between these 
six most common contagious diseases. It frequently 
occurs that the disease so differs from the accepted 
type, that its recognition is extremely dif^cult, requir- 
ing a careful consideration of symptoms and condi- 
tions, the enumeration of which is impracticable. In 
all cases the early summoning of the family physician 
is urged. 



Diseases 





h 

5 

"Si m 


Pneu- 
irculo- 
ea Di- 
isease 


!^ 


ease,, 
sease, 
ease, 
eight's. 


1 

bo 


;e, or 
eases, 
sease. 
f Soft. 
udden 






r 

a 


Broncho - 
mia. Tube 
, Diarrhoi 
Lses,EyeD 
r Disease, 





Ear Dis 
:eart Di 
land Dis 
narmia, Bi 
isease. 


.2i 

^ © 


Ear, Nos 
roat Dis 
dney Di 
ralysis 
late and S 
ath. 


Bronch 
3ncho-Pn 
L, Pulm< 
thisis. 




o M ™ ee 






J-rH ce Cfl © 


^•2 -=5 




1— 1 


a-j^Sw 




fflOOQ 


a 


h^^pmQ 


ffl aPh 




c^a 






© 










O O w 






ic 










ration > 
ase fr 
First 
mptom 


^1 


s ^ 

CO ^ 


O o 




il 


s s 

«3 ^ 




s © >. 






m 










fi.s ^ 






^ . 










p 






73 












T3-0 i 


TJ.A 


© SH-rt itH be 




.i ^^ ^ © "3 


;,4 




II 




ee o 


SOI 

g(c 
a n 
late 
elin 


© 

> 


deb 
roa 
rdii 
nos 
and 


3 


in 


.^i-^ 
^ fl^ 


©•^ 

II 


Starts with 
roat, vomitin 
nvulsions) j 
gh fever, 
;hing and fe 

skin. 


J 


Slight fever, 
y, sore th 
3upy cough, 
arge from the 
largedneckgl 


fee 


o 
w 

Q 

M 

i 

c 

o 

o 


o 


starts 
es, wet 
ugh wit 

ss. 


^-2 
3-2 




h 




>»o 2 


M o-:2_S=4-i 




.•+f j;^ a 







© o a 


^•S 


■S o^.t^ o 




^ s) 





istic Symp- 
which the 
is Recog- 
zed. 


red spots, 
levated be- 
n face and 
rover body. 


pink spots 
3 beginning 
nd extend- 
y over body 


Continuous bright 
red rash, extending 
from neck down- 
wards over trunk 
and limbs. 


red blisters 
and body, 
n of wheat 
lea in size. 


: s h white 
e on throat 
behind the 
or in the 


rent pro- 
roxysms of 
ithorwith- 
)p) fermin- 
gagging or 


3 


Character: 

toms by 

Disease 

ni 


Dusky 
slightly e 
ginning o 
spreading 


Bright 
or papule; 
on face a 
ingrapidl 


Scattei 
on face 
from grai 
to split p 


Greyi 
membran 
or hidden 
palate 
Larynx. 


Recur 
longed pa 
cough (wi 
out whoc 
ating in ; 
vomiting, 




=4-< 6 © , 










1. 






O efl-r3 aM 


^ ^ 


m as 


1 ^ 








Pds^^ 


-^ ni 


IH ^ 


w T! 


,-( ,^ 


1fi 


^ % 




© 

fi ^ -^ aM 




J] M 


t- m 




w 


^ w 




Froi 
Expos 
to 
Firs 
Sym 
tom 


s ^ 


s ^ 


i ^ 


s s 


^ 


3 ^ 




1-1 


^-^ 


M T3 


a' 


:; ^ 


^ '^ 




^ 






© — ^ 


t^ 








1 




a1 - 


s g 


o u 
■3 =* 


'J 
© 


be 1fi 

III 
|5| 






as 


SIS 


cgS 


6t 


ft 


^ fe 



162 



THE MEDICINE CHEST 163 

THE MEDICINE CHEST 

A little learning is a dangerous thing, so too is a Hygiene 
razor in the hands of a child. Much more harm may Medicine 
follow the unskilled use of drugs than from their neg- 
lect. Pernicious as is constant ''doping" for the adult, 
it is much more so for the child. A complicated medi- 
cine chest may become a source of endless mischief in 
the household. 'If it does no good it can not do any 
harm" may be said of nothing possessed of any po- 
tency for either good or evil. The following is a brief 
list of remedial agents for the nursery: 
Alcohol. 

Alboline (or Lavoline) for daily use in the atomization of 
nose and throat. In nasal catarrh a physician will 
give a prescription for a medicated aboline. 
Boric Acid. A solution of a tablespoonful to a pint of boil- 
ing water, cooled and strained through gauze into at 
sterilized bottle, may be used as a gargle or wherever 
a mild antiseptic wash is needed — cuts, bruises, etc. 
Bicarbonate of Sodium. 
Brandy. 

Bromide of Sodium — In five grain tablets, for convulsions. 
Castor oil — the most effective and least harmful cathartic. 
Usual dose, 2 to 6 months, i teaspoonful of castor 
oil and sweet oil mixed ; under 2 months, half the 
amount of the mixture ; up to i year, about i tea- 
spoonful of castor oil; i to 4 years, i^ to 2 teaspoon- 
fuls or more, according to susceptibility. To a child 
old enough to find the taste objectionable the castor 
oil may be given in a little warm milk or coffee and 
milk, followed by more milk, lemonade or peppermint 
candy. 



i64 CARE OF CHILDREN 

Ipecac, Syrup of. — As an emetic give a year oM baby ]4 tea- 
spoonful, followed by drink of warm water. Repeat 
dose every 15 minutes until vomiting. 

Lime Water. 

Mustard. 

Peppermint, Essence of. 

Sweet oil. 

Vaseline. 



Absorbent Cotton, antiseptic. 

Adhesive Plaster. 

Alboline Atomizer (Constructed to spray oils). 

Ear and Nose Syringe. (Soft rubber.) 

Fountain Springe. 

Flexible rubber Catheter, number 10 (for rectal tube). 

Gauze, antiseptic. 

Hot water bottle. 



HYGIENE OF THE CHILD AND YOUTH 

Getting: the baby out of*arms should not diminish More Care 

/ , , \ , . Not Less 

the mother s care, but the same protection as given 
in the nursery should extend throughout childhood, 
with such modifications as the changing anatomy and 
physiology demand. In fact, the child of two or three 
years should receive more of her time and thought 
than the younger babe, for it is now that his training 
in personal hygiene should begin and habits of per- 
sonal cleanliness be established. After infancy, the 
danger from death may be lessened but not of per- 
verted development. 

The fact that a child is able to dress himself does 
not relieve the mother of the responsibility of seeing 
that he is properly clothed, and even though he is old 
enough to sit at the family table, especial attention 
must still be given to his diet and manner of eating. 
Thorough mastication is a most important feature of 
the child's early training and he should not be allowed 
to ''wash down" his food. He should eat some foods 
requiring vigorous mastication, such as toast and hard 
cracker, to help in developing strong teeth. 

Too frequently the temporary teeth are neglected Care_of 
both as to personal and dental care under the mistaken 
impression that their early loss renders them of little 
importance. Even were this true (which it is not) 
the health and comfort of the child would suggest 
that they be kept clean and in perfect condition as long 

166 



the Teeth 



i66 



CARE OF CHILDREN 



Care of 
the Throat 



Deep 
Breathing 



as they remain. To accomplish this end the teeth 
should be thoroughly brushed and the mouth cleansed 
with a pleasant antiseptic, such as dilute listerine, boro- 
lyptol or glyco-thymoline, night and morning (especi- 
ally at night) and the slightest decay of the teeth 
should be referred to the dentist. 

After a child is taught to properly cleanse his mouth 
it is but a short step to teach him to gargle and this 
mastered a little tact and patience on the part of the 
mother or nurse will soon initiate him into the use of 
the atomizer and nasal douche, accomplishments which 
may prove of inestimable value at some critical time. 

Every night and morning (oftener if necessary) the 
nasal passages should be freed from excessive secre- 
tion, not only so that the child can breathe through 
his nose but to get rid of material which harbors in- 
fections. The child should early be taught the use 
of the handkerchief and required to carry his own 
and impressed with the danger of contact with those 
soiled by others. 

Any tendency to mouth breathing should be immedi- 
ately corrected and if necessary the advice of a physi- 
cian sought. 

Deep breathing should be early taught and insisted 
upon until it becomes a firmly established habit. This 
cannot be accomplished with unsuitable clothing or 
without correct postures in standing, sitting and walk- 
ing. Frequent exercise in the open air, such as taking 
a deep inspiration while five, ten or even fifteen sec- 



HYGIENE OF THE CHILD 167 

onds are being counted, may be made a game of com- 
petition. 

The need of plenty of sleep throughout the entire sleep 
developing period can not be unduly emphasized and 
to this end quiet, well ventilated chambers and indi- 
vidual beds are necessary. 

Young children should retire soon after the light 
supper. Studying, playing or reading by artificial 
light may interfere with the rest and recuperation 
required after the fatigue of the day. 

The frequency, duration and temperature of the Bathing 
bath should depend upon the reactionary effects upon 
the child. A cold tonic shower bath is best given in 
the morning and should not last more than half a 
minute. The child should stand in warm water which 
covers his feet and be gently sprayed with warm water 
before turning on the cold shower. If a shower bath 
is not available, a quick sponge with tepid to cold 
water with a brisk toweling may be given. The 
advisability of the cold baths should be decided by the 
family physician, as all children should not take them. 
The warm bath may be given before retiring if suffi- 
cient time be allowed for the digestion of the supper. 
General bathing should never immediately follow a 
meal. 

EDUCATION 

Childhood is recognized as the piaytime of life and 
most of the plays of children are educational in their 
tendency. That physical development and training 



i68 



CARE OF CHILDREN 



Games 
for Girls 



Development 
of the Brain 



should take precedence of the mental is self-evident to 
all who witness the sad spectacle of an over-trained 
mind in a feeble body. 

In childhood, at least, girls should share the outdoor 
sports of their brothers. There is no reason why the 
pleasurable and useful exercise of running, jumping, 
swimming, rowing, skating, riding, cycling and most 
games should be confined to boys. The cry of ''tom- 
boy" has deprived many a girl of the physical founda- 
tion for the duties and responsibilities of mature 
womanhood. 

Rousseau says, and truly, the weaker the body is, 
the more it commands; the stronger it is, the more it 
obeys. 

*'A well-trained nervous system is the greatest friend 
that the mind can have." — Halle ck. 

The country affords special advantages for the nor- 
mal development of the child, for here it is that he 
comes close to nature which furnishes innumerable 
.object lessons and problems which his inherent curi- 
osity impels him to solve. Thus he is led to develop 
himself through a symmetrical training of muscles 
and brain. For the city child, these conditions should 
be approximated as nearly as possible. 

The brain, relatively large, even at birth, is suscepti- 
ble of very rapid development. If, however, this be 
allowed to exceed that of the muscles, irreparable dam- 
age may result and mediocrity take the place of early 
precocity through early exhaustion of the brain cells 
from over stimulation. It must never be forgotten 



HYGIENE OF THE YOUTH 



169 



that young nerve cells tire quickly, not yet having the 
stored energy of maturity. 

The younger the child the more should the early 
educational efforts be restricted to the larger groups 
of muscles, — leg, arm and body exercise rather than 
those of the fingers and smaller groups of muscles 
which require concentrated efforts at finer co-ordina- 
tion. The use of the needle, pencil, brush and scissors 
may well be deferred and replaced by romping games, 
efforts at house building with large blocks or shovel 
and sand pile. 

The proverbial laziness of the boy of eight years is 
based upon a physiological fact which is too frequently 
overlooked. His heart at this time has not kept up 
with the rapid growth in body length and is barely able 
to maintain the circulation of the blood for ordinary 
mental and muscular exertion. He is least fitted at 
this time for the extra demands made upon him for 
running errands and doing all sorts of chores which 
he usually does clumsily and tardily because of ex- 
cessive fatigue. Many boys and girls are stunted for 
life or succumb to infectious disease from excessive 
burdens imposed during this period of weak heart, 
namely, from the eighth to the twelfth year. 

It has been shown often that the purpose of our so- 
called educational systems has been defeated by ig- 
norance of the child's capacity for concentrative atten- 
tion to a given subject. Fifteen minutes is about the 
limit for a child between five and seven years of age 



Period of 
Weak Heart 



Limit of 
Attention 



170 



CARE OF CHILDREN 



Eye and Ear 
Strain 



and the grammar school pupils rarely show a ca- 
pacity for more than thirty minutes of uninterrupted 
study. This power may be even further reduced by 
debilitating conditions, such as improper food, im- 
paired digestion, physical fatigue, insufficient sleep or 
vitiated air of the school room. 

6 y a 9 lo • 11 12 13 14 15 16 YEA3i 





/ 


\ 

\ 
\ 


_ 


\ 














^ 


/ 


\ 




\, 














^x. 


f 


\ 


)Y3 




\ 

\ 
\ 

\ 

\ 


\ 


/ 


\ 


y 














- o 


:RI- 


S 








-^. 


.-. 





Krohn's Diagram Eepresenting Relative Time of Fatigue 

at Diiferent Ages. 

Early exhaustion of nerve force is frequently in- 
creased by eye strain from defective vision and pupils 
often appear dull at school because they can not see 
distinctly maps, charts or blackboard exercises. In 
the same category as a cause of apparent mental dull- 
ness is defective hearing, — the words of the teacher 
failing to make a definite impression upon the child's 
sensorium, with resultant confusion of ideas. In this 
respect a grave responsibility rests upon parents and 
teachers. The oculist and aurist should be frequently 



PUBESCENCE 171 

consulted and any defects in these' "avenues to the 
mind" corrected. 

The subject of school-room hygiene is too broad to school 
receive more than passing mention here. The parent 
should visit the schools and satisfy himself as to the 
heating and ventilation of the rooms in which his chil- 
^dren spend so many hours. The seating with refer- 
ence to light and vision, adaptation of seat and desk 
to the size of the child so that undue fatigue or actual 
deformity may be obviated, should also be given con- 
sideration. Is there a judicious alternation between 
mental concentration and free-limbed exercise suitable 
to the child's age? 

PUBESCENCE 

Pubescence is a period of the greatest importance in 
the development of the child, not only physically but 
mentally and morally. 

The rounding out of the girl's physique with broad- Changes 
ening of the hips and rapid growth of the breasts sug- Girl 
gests the approach of menstral function. This should 
never be allowed to take the little maiden by surprise, 
but the mother should have prepared her daughter's 
mind for this sign of womanhood. Unfortunate is the 
girl whose mother has not had the tact and courage to 
instruct her beforehand concerning the true meaning 
of conception, gestation and motherhood. Many lives 
have been lost or ruined' because the mother has failed 
in her duty in this respect. 

Probably the best argument for the early study of 



172 CARE OF CHILDREN 

biology, including botany, is the natural introduction 
thus afforded to the great mysteries of ovulation, fruc- 
tification, conception, gestation and parturition and the 
true physical relation of the sexes in the great plan of 
life. There is nothing to shock the modesty of the 
normal girl if these subjects are properly approached 
along the lines of comparative biology. 
Care The pubescent girl's periodical indisposition should 
be recognized and guarded from undue burdens and 
responsibilities, as the foundation for future suffering 
and disease is often laid at this time. The woman is 
fortunate whose pubescent life escaped the crippling 
effect of tight or high-heeled shoes, whose anatomy 
has not been distorted and generative organs disar- 
ranged by the corset, and whose moral and social edu- 
cation has followed natural family and domestic lines 
rather than the artificialities of the so-called modern 
society. 

Wholesome companions and literature, out-of-door 
exercises and amusements with reasonable domestic 
responsibilities should alternate with judicious selec- 
tion of musical, physical and literary curriculum in 
well-selected schools. 

The judicious parent will endeavor to teach the pu- 
bescent boy manliness rather than mannishness, and 
to inculcate early reverence and respect for pure 
womanhood. He should have the companionship of 
pure-minded girls. 
The Boy The boy ought to be taught by a senior whom he re- 



PUBESCENCE 



173 



veres (preferably his father) the true meaning of sex 
differentiation and sexual. passion. It should be clearly 
shown him that venereal disease with its far-reaching 
baneful effects lurks ever as the penalty for licentious- 
ness. He should be given to understand that an oc- 
casional seminal emission while sleeping is no more 
sinful than a transient hemorrhage from overcharged 
blood vessels or vomiting for an overloaded stomach. 
Above all, he should be taught to respect his own 
body. 

Here again competitive athletic sports, good litera- 
ture, the study of natural sciences with abundance of 
out-door life will lead the boy away from tendencies 
toward immorality and dissipation. 

Close confinement to books and literature too fre- 
quently causes physical and mental collapse during 
pubescence, for which the prizes for scholarship are 
not infrequently responsible. Plenty of fresh air both 
day and night and the daily cold bath are items of tre- 
mendous value in the hygiene of pubescence. Empha- 
sis and encouragement to physical development should 
be given by the parent at this time (and at all times). 
Better take the boy or girl out of school for a term or 
two, if necessary, than to harm his body for life. Book 
learning can easily be made up, but perverted physical 
development often can never be rectified. 



Physical 
Development 
Most 
Important 



174. CARE OF CHILDREN 

BIBLIOGRAPHY 

Care of the Baby ($1.50, postage .18). J. P. Crozer Griffith, 

M. D. 
Care of a Child in Health ($1.25, postage .12). N. Oppenheim, 

M. D. 
Care and Feeding of Children ($.75, postage .08). L. E. Holt, 

M. D. 
Century Book for Mothers ($2.00, postage .18). Yale and Pol- 
lock. 
Development of the Child ($1.25, postage .12). N. Oppenheim, 

M. D. 
Hygiene of the Nursery ($1.00, postage .08). Louis Starr. 
Theory and Practice of Infant Feeding ($2.25, postage .20). 

Henry Dwight Chapin, M. D. 
Food and Principles of Dietetics ($3.00, postage .26). Robt. 

Hutchison, M. D. Chapters 24, 25, 26. 
School Hygiene (For teachers) ($1.00, postage .10). Edward 

R. Shaw, 

Medical Books 
Diseases of Children ($3.50). A. C. Cotton, M. D. 
Pediatrics — Hygiene and Medical Treatment of Children 

($6.00). T. M. Rotch, M. D. 
Diseases of Infancy and Childhood ($6.00). L. E. Holt, M. D. 



TEST QUESTIONS 

The following questions constitute the "written reci- 
tation" which the regular members of the A. S. H. E. 
answer in writing and send in for the correction and 
comment of the instructor. They are intended to 
emphasize and fix in the memory the most important 
points in the lesson. 



CARE OF CHILDREN 

PART 111 

Read Carefully. Place your name and address on the first 
sheet of the test. Use a light grade of paper and write on 
one side of the sheet only. Leave space between the answers 
for the notes of the instructor. Answer every question fully. 
Read the lesson paper a number of times before attempting 
to answer the questions. 

1. Does crying benefit the baby? If so, how? 

2. Describe different cries and give their interpre- 

tation. 

3. What do you understand by nervousness in a 

child? 

4. Name some causes for nervousness and the 

symptoms. 

5. (a) What does fever indicate in an infant? 
(b) What may be done for its relief? 

6. (a) What is an ordinary cold? 
(b) Why is no cold trivial? 

7. Give the cause of sore throat. 

8. (a) What is the "anarchist's den"? 
(b) How may it be cared for? 

9. What contagious diseases are the most danger- 

ous and why? 

10. Mention the possible after effects of measles. 

of scarlet fever. 

11. What causes convulsions? Why are they to 

be dreaded? 

12. What should be done for their immediate re- 

lief? What for their prevention? 



CARE OF CHILDREN 

13. Mention two important items in the care of 
whooping cough? 

14. Why should a physician be called immediately 
in a case of suspected contagious disease? 

15. How may scurvy be prevented? 

16. What is rachitis? How may it be prevented? 

17. What are the dangers of a discharging ear? 

18. How would you guard the baby against sum- 
mer complaint? 

19. What can you say as to treatment for consti- 
pation ? 

20. What is the aim of education? 

21. What to you are the most important points in 
the hygiene of the school child ? 

22. Pubescence, — what does it mean in the life of 
the boy and girl ? 

23. What questions have you to ask? 

Note — After completing the test, sign your full name. 



SODIUM CITRATE IN INFANT FEEDING* 

By a. C. Cotton, M. D. 

The infant deprived of the breast must, in relation 
to his feeding, be regarded as a pathologic problem. 
That this statement is axiomatic is shown by the fact 
that more earnest work has been bestowed on infant 
feeding during the past twenty years than on all other 
pediatric subjects combined. That the problem is 
still unsolved the high relative mortality and later 
morbidity (illness) of artificially fed infants bear 
constant witness. 

The six essentials of Cheadle, enunciated by that 
observer some time in the '8o's, bear witness that the 
essential requirements of an artificial food for babies 
were broadly understood twenty years ago. Quoting 
from memory, they are briefly as follows: i. Steril- 
ity. 2. Antiscorbutic property. 3. Quantity. 4. 
Some Animal constituents. 5. Form suitable. 6. 
Constituency. Much has been learned since Cheadle 
by amassing clinical results and observations. Mean- 
while the deductions from a priori reasoning have 
proven unsatisfactory for the simple reason that so 
little was known of the physiology of infant digestion. 
Latterly the premises from which we reasoned have 
been proven, almost without exception, to be incor- 
rect. 

* Read in the Section on Diseases of Children of the American Medical 
Association, at the Fifty-seventh Annual Session, June, 1906. Reprinted 
from the Journal of the American Medical Association of October 6, 1006. 

179 



l8o CARE OF CHILDREN 

Thus the great American experiment known as 
the exact percentage method of feeding required 
that the baby's diet should consist wholly of cow 
products and water, so modified in its five gross 
constituents as to coincide quantitatively with simi- 
larly named constituents of average breast milk. 
One other ingredient only was allowable in this 
feeding mixture, viz., some alkalin solution, as lime 
water, sodium bicarbonate, or magnesia. This dogma, 
which in connection with laboratories established 
throughout the country had almost become a cult 
in infant feeding, was practically based on seven 
assumptions, which have recently been proven 
erroneous, to wit: 

1. The qualitative similarity in breast and cow's 
milk of the lactose, fats, albuminoids, proteids and 
their chemical combination with the milk salts. 

2. The claimed alkalinity of breast milk in contra- 
distinction to the acidity of cow 's milk. 

3. The possibility of a synthetical substitute for 
breast milk from cow products alone. 

4. The claim that cereals were not allowable 
because indigestible in the infant's secretions and 
that they induced dyspepsia and intoxication by 
acting as decomposing foreign matter. 

5. That cereal gruels were no more efficient in the 
prevention of dense milk coagula than dilution with 
plain water. 

6. That HCl played no part in the digestive process 
until later infancy. 



SODIUM CITRA TE IN INFANT FEEDING i8i 

7 . That the important proteid content of the baby 's 
food could be made up from the non-coagulable whey 
albumin of cow's milk. 

The elucidation of facts in refutation of these prem- 
ises is due to the earnest work of a number of men, 
prominent among whom as members of this associa- 
tion may be mentioned Chapin on cereal gruels and 
gastric development, Kerley on milk reaction and 
alkalinization, Shaw on HCl secretion in infants, 
Stern on milk fats, Southworth on the art versus the 
science of infant feeding, Morse on acidified milk and 
buttermilk feeding, and the recent unsurpassed work 
in chemistry of milk by Van Slyke and Hart at 
Geneva. Most of these contributions have enriched 
our literature and become familiar to all. The 
subject is still a broad one. I disclaim any intention 
of attempting in this limited paper to deal with it in 
toto, and indulge in these preliminary observations 
merely to emphasize the fact that no royal road to 
successful feeding by exact mathematical formulas 
has yet been found. Nor do I wish to convey the 
impression that I would belittle the value of attempts 
at accuracy in determining the component parts of 
the infant's dietary. 

Great credit is due and will ever be associated with 
the name of Dr. Rotch as the founder of a system 
which has not only served as a hypothesis for tenta- 
tive feeding, but has stimulated to greater accuracy 
and more careful clinical observation and recording 
of results than was possible by any other method. 



i82 CARE OF CHILDREN 

As an enthusiastic advocate of the so-called American 
method, I am on record frequently both at home 
and abroad. I may be pardoned if I suggest that the 
tendency in general is too much along the line of the 
refinement of mathematical formulas to the neglect 
of the obvious importance of gastric development 
along normal physiologic lines. 

The spectacle of a marantic infant with persistent 
curds in the stools, though cow proteids have been 
reduced to the extreme limit of attenuation by dilu- 
tion with water, is a familiar one. So, also, too 
commonly in evidence is the child, fed long but not 
nourished, on whey proteids and cream, whose gastric 
vigor has not progressed beyond that of early infancy. 

Important as the role of carbohydrates and fats in 
infant development may be, and difficult as the pro- 
blem of properly dealing with fats is, it is to the 
management of the proteids that I beg to call your 
attention in the few minutes allowed. Their impor- 
tance in the nutrition of the child needs no emphasis, 
as it is universally accepted both theroetically and 
clinically. 

The intolerance of the infant's digestive organs to 
cow proteids, so widely different from those for which 
they were intended, is also well known. Of the many 
methods in vogue for the establishment of toleration of 
these refractory curds the one most common, unfor- 
tunately, is their quantitative reduction by dilution 
far below percentages absolutely necessary for the 



SODIUM CITRA TE IN INFANT FEEDING 183 

development and growth of the child. In fact, the 
common advice to infant feeders on percentages of 
milk in recognition of its refractoriness, is either to 
restrict the proteid percentage far below that which is 
known to obtain in average breast milk (as though 
Nature would commit the absurdity of elaborating 
the necessary amount of proteid from even a less 
quantity when presented in the more obstinate form 
of cow casein), or to substitute the non-coagulable 
prbteids of whey. 

In either case Nature is cheated of her absolute 
demands. The pathetic malnutritional results of 
low proteid feeding, both immediate and remote, are 
too familiar to us all to need further elaboration. 
Aside from this slow starvation and stunted growth 
with its diminished resistance to intercurrent disease 
from insufficiency of nitrogenous food, abundance of 
proteids is demanded in a coagulable form for the nor- 
mal development of the gastric function, as ably 
shown by Chapin and corroborated by a host of clini- 
cal observers. This the infant gets at the mother's 
breast in proteids which clot on admixture with the 
gastric contents in soft, flocculent, semi-solid coagula 
which readily pass the pylorus in a form suitable to 
intestinal digestion and absorption. 

The important question, then, in feeding cow's 
milk is not how to reduce the proteids and sustain 
life, but how to increase the proteids and maintain 
unimpaired digestion. Buttermilk has been tried: 



1 84 CARE OF CHILDREN 

acidulated milk has been tried; admixture with 
gruels has been tried; koumiss, matzoon, and kephir 
milk have been tried; the addition of various alka- 
lies is much in vogue ; all with varying degrees of 
success, and each measure has its ardent advocates. 
That the question is not yet settled this diversity of 
opinion amply indicates. It is still an open field, and 
the cry that no chemical tampering with the milk 
should be encouraged need deter no one, since it is 
proven beyond dispute that cow's milk, however 
modified, is not a natural food for the human infant. 
The more orthodox observers of the original labora- 
tory percentage modification have from the first 
chemically tampered with the milk in the addition of 
lime water, sodium bicarbonate, etc., in the mistaken 
notion of humanizing the mixture by rendering it 
alkalin. That we reached further than we intended 
in our administration of alkalies and secured tolera- 
tion of the curds through neutralization of the normal 
gastric acids does not lessen the evils of inhibition 
of those digestive processes which can occur only in an 
acid medium. 

Since deductive methods from a priori reasoning 
have thus far failed of a satisfactory solution of this 
problem, let us welcome inductive methods conducted 
along rational lines, since massed clinical evidence 
must ever be the tribunal before which all method 
must come to trial. Whether secundtis artem or 
secundus scientiam, it is the greatest number of babies 



SODIUM CITRA TE IN INFANT FEEDING 1 85 

who live and thrive and resist disease that demon- 
strates the merits of their hygiene. 

It is with the firm conviction that sodium citrate, 
through its inhibition (prevention) of dense coagula- 
tion of cow's milk in the presence of an acid and 
rennin, may prove valuable in the solution of the 
proteid problem that I present a brief resume of my 
experience with this agent. 

More than two years ago in a personal letter from 
one of my assistants, Dr. J. W. Vanderslice, who was 
studying abroad, my attention was called to this 
use of sodium citrate. The reports from Dr. F. J, 
Poynton's clinic at Great Ormond Street, London, 
from which the writer as an eye witness drew his con- 
clusions, seemed sufficient to justify a careful con- 
sideration of this new method of overcoming some 
of the obstacles in the adaptation of cow's porteids 
to infant digestion. 

Rather cautiously, I began prescribing the citrate 
in cases in which varying milk mixtures had been 
used with poor success. Later, as I found that 
infants would tolerate a larger proportion of the milk 
in the feeding mixture when citrated, than by any 
other modification known to me, I used it more boldly, 
so that during the past two years I find a record of its 
employment for a longer or shorter period in more 
than 50 cases in both hospital and private practice. 
I have here, by the courtesy of Dr. J. D. Merrill, a 
report of 8 cases in which she has carefully observed 



i86 CARE OF CHILDREN 

its effects for a considerable time, also, by the courtesy 
of Dr. Vanderslice, a history of 29 cases reported by 
him at different times to the Chicago Pediatric Society. 
In addition to this I have read carefully Dr. Shaw's 
report of 22 cases, making a total of 1 12 cases embrac- 
ing nearly all conditions from simple dyspepsia to 
marasmus and ranging in age from the new born to 
adults who have suffered from milk dyspepsia. 

Sodium citrate being very soluble in water, the 
method of employment is simple, as follows: An 
aqueous solution is ordered containing from i to 5 gr. 
to the dram. A quantity of this solution is furnished 
the mother or nurse with instructions to add to the 
baby's bottle immediately before feeding enough of the 
solution to represent I, 2, or even 3 gr. of the citrate 
to each ounce of milk in the feeding mixture, accord- 
ing to the prescriber's idea of the requirements. The 
feeding mixture may consist of varying dilutions of 
milk with water or gruel, with the addition of cane or 
milk sugar, with or without cream. No alkalies are 
added, the sodium citrate used being a neutral salt. A 
most noticeable feature in this method of feeding is the 
large proportion of milk in the feeding mixture that 
the infant will tolerate without evidence of gastric 
disturbance or the appearance of any considerable 
amount of undigested casein in the stools. In fact, 
the stools of babies fed on citrated milk have come 
to be regarded by Drs. Merrill, Vanderslice, and 
myself as positively characteristic, being firm enough 



SODIUM CITRA TE IN INFANT FEEDING 1 87 

to show form on the diaper, free from fecal odor, and 
homogeneous in color and consistency. The slight 
tendency to constipation mentioned by Dr. Vander- 
slice I have observed in a number of cases. This I 
attributed to the low percentage of fat in the food 
consisting of equal parts of milk and water or even 
one part of milk to two of water. In but few instances 
have I observed this constipation where the fat 
content of the mixture equaled 3 per cent. * 

One indication for the increase of the sodium 
citrate, even in some cases to as high as 3 gr. to the 
ounce of milk, is vomiting of curds. Another indica- 
tion is the appearance of curds in the stools, care 
being taken to exclude indigestion from excess or. 
intolerance of fats. Of the stools, J. H. Salisbury, 
professor of chemistry, to whom they were submitted, 
reports as follows: 

Three samples of the feces of infants fed with milk modi- 
fied by the addition of citrate of sodium were examined. 
The feces were yellow, of a moderately firm consistence and 
remarkably homogeneous. On microscopic examination a 
few round masses, probably calcium soaps, could be seen 
scattered through the otherwise very fine debris. In two 
specimens short crystals of soap could be detected. No 
free fat was found. On treatment with acetic acid more 
or less acid crystals could be observed and in one specimen 
this was especially marked. Chemical examination of one 
specimen for proteids was negative. 

The duration of the administration of the sodium 
citrate, as well as the quantity employed, varies con- 
siderably in different cases, the .purpose being to 



1 88 CARE OF CHILDREN 

bring the baby's feeding tip toward whole milk as 
rapidly as possible. As toleration is established the 
amount of citrate is reduced to one, to one half and to 
one fourth of a grain per ounce of milk until it can be 
discontinued. It happens not infrequently that the 
citrate is profitably resumed on the recurrence of 
signs of indigestion. In but 6 cases have I felt 
obliged to discontinue the citrated milk and adopt 
other methods of feeding. Some of these were among 
my early cases which, if occurring later, would pos- 
sibly have received a more persistent treatment with 
citrated milk. 

In consideration of this subject three questions 
naturally arise: i. Is the employment of sodium 
citrate any better than other methods of rendering 
cow proteids tolerable and digestible? 2. Is its 
employment harmful? 3. In what manner does 
it act ? 

In answer to the first I would say that this method 
seems to allow a more rapid increase in the propor- 
tion of milk ingested than any other known to me. 
Moreover, the frequency of relief from milk indi- 
gestion on the addition of the citrate and the favor- 
able reports from all whom I have known to give 
it a thorough trial are not without significance. 
In regard to its harmfulness, no case of citrated 
milk feeding has been brought to my attention in 
which there appeared to be cause for regret because 
of the employment of this method. 



SODIUM CITRA TE IN INFANT FEEDING 1 89 

Concerning its manner of action in a chemical 
sense, there appears to be some difference of opinion. 
Professor SaHsbury, above quoted, to whom the 
question was submitted, states as follows: 

Citrate of calcium is insoluble in water, but dissolves readily 
in solutions of the alkali citrates. It is to be presumed, 
therefore, that when a solution of sodium citrate is added 
to milk, which contains calcium in combination with casein, 
a reaction would occur producing a sodium combination 
of casein and an insoluble calcium citrate. The latter 
would dissolve on the addition of an excess of sodium citrate. 
It is to be presumed, therefore, that the milk treated with 
citrate of sodium contains a sodium compound of casein 
and calcium citrate held in solution by the presence of sodium 
citrate. Such milk would not yield a curd containing an 
excess of calcium, but the calcium would be found in the whey 
as well as in the curd. The experiments of Dr. R. Aibinder 
do not contradict the theory of Poynton that sodium citrate 
acts by separating the calcium from the casein, thus render- 
ing it less easily coagulable. Sodium citrate would react 
with hydrochloric acid solution to form sodium chlorid and 
citric acid. The decomposition would not be complete but 
so nearly so that a large quantity of sodium citrate would 
neutralize nearly all the free hydrochloric acid of the gastric 
juice. Too large an amount of sodium citrate in the milk 
might, therefore, interfere with the digestion of proteids 
in the stomach. Such digestion might occur in the intestine 
from the action of the pancreatic juice. 

The physical behavior of citrated milk in vitro, 
outside the body, is obvious and may be demonstrated 
in a simple manner suggested by Wright and Poyn- 
ton, who first exploited this method of feeding. Into 
each of two test tubes containing equal quantities of 



190 CARE OF CHILDREN 

milk (to one of which sodium citrate has been added) 
drop a given quantity of Hquid rennet and dilute 
hydrochloric acid. In both milks coagulation occurs, 
with this difference, that the citrated milk clots less 
promptly and the resultant curd is softer, less dense, 
more nearly resembling the curd of breast milk. 

My assistant, Dr. F. W. Allin, as the result of more 
than a hundred careful comparisons, has obtained 
the following results: 

Materials Used. — Ordinary dairy milk was used 
in these experiments. Wyeth's liquid rennet was 
used for curdling agent, which was always added 
last. A I per cent hydrochloric acid solution and 
4 per cent sodium citrate solution were used. Two 
drops of HCl in 5 c.c. milk equals .025 per cent. 
Five drops of sodium citrate solution equals .25 per 
cent. One grain of sodium citrate to the ounce of 
milk would be .20 per cent. The gruels were stand- 
ardized to one ounce of flour or oatmeal to the quart 
of water and cooked three hours in a double boiler. 

Conditions. — The experiments were all performed 
at 40 C. in glass test tubes. The milk was used as 
whole milk or diluted with water, flour gruel, or oat- 
meal gruel. The dilutions made were two thirds, 
one half, one third, one fourth, one eighth milk. 

CONCLUSIONS 

I. Sodium citrate in 25 per cent, or more, retards, 
and very high percentages will inhibit coagulation. 



SODIUM CITRA TE IN INFANT FEED INC 19I 

2. The presence of HCl hastens coagulation. 

3. Diluting milk generally retards coagulation. 

4. Gruels appear to have little or no effect in 
retarding coagulation more than water when the 
the citrate is used. 

5. The coagula of citrated milk are softer, smooth- 
er, and more jelly-like or more flocculent than those 
of milk not thus treated. 

The simplicity of this method commends itself, 
especially in dispensary and out-patient practice, 
where the mother's demand for "medicine" for the 
baby's dyspepsia may be met by the standard solu- 
tion of sodium citrate to be administered in teaspoon- 
ful dose in each bottle of the feeding mixture. In 
private practice it furnishes another rational method 
of infant feeding. 

1485 Jackson Boulevard, Chicago. 

Editor's Note. This article, intended for physicians, is 
included here only to inform mothers and nurses of the 
latest and seemingly, a very important development in the 
artificial feeding of infants. It is obvious that this new 
method should be tried only under the direction of the at- 
tending physician. 

Sodium citrate is made by neutralizing citric acid with 
soda Citric acid is the acid found in lemons, oranges, and 
some other fruits. As stated, sodium citrate unites wnth 
some of the lime (calcium) compounds which make the clots 
of cow's milk more dense than those of mother's milk. 



THE SOOTHER* 

By a. C. Cotton, M.D. 

In these days, the inahenable right of a child to 
protection, especially during the helpless period of 
infancy, no thoughtful physician questions. Even 
the lay mind seems to have grasped the idea that 
the infant should be guarded against all influences 
detrimental to his normal growth and development. 

It is well recognized that one of the commonest 
causes of infant mortality and morbidity is to be 
found in disturbances of the digestive tract. That 
these disturbances are commonly due to infections 
is generally admitted. Much is yet to be learned 
in regard to the exact nature of these infections, but 
all observers seem to agree upon two principal 
sources of infection, viz., exogenous and endogenous. 
In the majority of cases of gastro-intestinal disturb- 
ance it is not easy to differentiate between these two 
sources. The term "Autointoxication" is frequent- 
ly heard as an explanation of gastro-enteric infec- 
tion in many instances in which the source of the 
infective material is in doubt. Enough is known 
however, both from clinical observation and bac- 
terial demonstration, that food infection, especially 
among nurslings, is the most frequent cause of their 
disorders; hence the recent revival of interest in the 

♦Reprinted from the Medical Brief, September, 1904. 

192 



THE SOOTHER i03 

milk supply and methods of handling the same, also in 
the means of protection from germs which might prove 
detrimental to the quality of the milk or injurious 
to the digestive apparatus of the infant. Pasteur- 
ization, and even sterilization, though undoubted- 
ly depreciating the food value of the milk as well as 
its digestibility, are advocated by many who would 
minimize the danger from the introduction of path- 
ogenic micro-organisms with the food. For the 
same reason, the improved hygiene, including the 
care of the nursing bottle, the sterilization of the nip- 
ple, the antiseptic care of the baby's mouth, and 
everything pertaining to the act or process of feed- 
ing, is widely practiced. 

The unanimity of the profession in regard to these 
details leads the writer to call attention to a glaring 
inconsistency in infant hygiene, which is so wide- 
spread as to come under the daily observation of 
every baby feeder. The long-tube nursing bottle 
is practically obsolete; indeed, some municipalities 
have enacted laws against the sale or use, for the 
evident reason which has been amply demonstrated 
— that the apparatus can not be kept germ-free. 
Great cedit is due to Doctor Ernest Mende, of Buffalo, 
for his vigorous and successful crusade against this 
death-dealing tube. As though the nursling had not 
enough to contend with in securing his right to 
protection in our unhygienic homes, it would seem 



l94 CARE OF CHILDREN 

that saturnine ingenuity were invoked to devise 
methods to introduce pathogenic micro-organisms 
into his very vulnerable digestive tract. 

Such an ingenious device I now refer to, as the 
"soother" conspicuously displayed for sale at all 
shops. So popular with the laity is this devilish 
invention that mothers and grandmothers wantonly 
teach the baby its use, and have been known to 
express regret when the" infant did not take to it 
kindly, because it appeared to be such a comforting 
habit when once established. 

Upon examination of the construction of this so- 
called "soother" and its method of employment, it 
is evident that no apparatus could be constructed 
to furnish a better medium for the collection and 
cultivation of a great variety of organisms, many 
of which are undoubtedly pathogenic to the nursling. 
Warmth and moisture are supplied by the baby's 
mouth and secretions. Germs, everywhere present, 
are planted upon this culture bed from frequent 
contact with hands and garments and furniture, 
floor, ground, and not infrequently, from the mouth 
of the mother or nurse. The contrivance itself, 
with its adhesive, retaining surfaces, its constrictions 
and ridges, its bone shield and stem with their crev- 
ices, depressions, and openings, its ornamental ring 
with fancy ribbon or filthy string by which it is 
attached to the person of the victim, all perform 
their part in the cultivation and colonization of 



THE SOOTHER - 195 

possibly death-dealing microbes. If any one is 
inclined to question the truthfulness of these state- 
ments, let him possess himself of the next " soother " 
that he meets in active operation, and examine 
smears from the accumulations in its grooves. His 
microscope and cultures will convince him of the 
truth of my statement. 

Pernicious as it may be, this daily- and hourly 
ingestion of infective organisms is not the limit of 
possible injury to the infant through means of the 
"soother." The subject of adenoid facies, so-called 
in its relation to the existence of troublesome aden- 
oids, has not escaped the attention of any student 
of child development. Peculiar conformation of oral 
and facial structures is commonly — perhaps too com- 
monly — attributed to the presence of the adenoids. 
That the adenoid face frequently appears as a 
familiar type is well known, and the etiological 
relationship of the malformation to the naso-pharyn- 
geal growths is a question not yet settled. That 
the adenoid face is found with the adenoids, is not 
proof that the former is due to the latter. That 
adenoids may cause mouth-breathing is evident. 
That mouth-breathing causes well-known deform- 
ities such as a narrowing of the palate, constriction 
of the inferior nasal meati, with deflection of the 
nasal septum, is not so apparent. That mere in- 
spiration and expiration through the mouth will 
cause, or even greatly influence the oro-nasal con- 



196 CARE OF CHILDREN 

formation, the writer does not believe, though he 
accepts the deformity or any other condition which 
interferes with free nasal respiration as prolific in the 
causation of naso-pharyngeal catarrhs, with hyper- 
trophy of adenoid tissue. The direct current in- 
spired in the mouth-breather incites tonsilar hy- 
peremia and hypertrophy, so that the familiar type 
of this deformity may prove the starting point to 
the lesions of the mucosa above mentioned. 

In the absence of heredity it may be questioned 
whether intrauterine conditions or pressure at the 
time of delivery, with or without forceps, may not 
influence the peculiar conformation known as "con- 
genital adenoid facies." Be that as it may, the 
fact is well known that an infant apparently normal 
at birth may gradually develop this oro-naso-facial 
deformity between the sixth month and the third 
year of its life. The not uncommon dental deform- 
ity produced by thumb sucking has been thoroughly 
exploited. Little, however, so far as the writer 
knows, has been said in regard to the effect of the 
continuous use of the "soother" in this connection. 
When we recall the plastic condition of the structures 
that make up the oral and nasal cavities, giving form 
to the infant face, and remember that ossification 
is incomplete at birth, proceeding only from numer- 
ous ossific centers with intervening areas of plastic 
tissue, it is not difficult to perceive that persistent, 



THE SOOTHER 197 

or continuously remittent pressure applied in the 
same direction will influence the shape of the struc- 
ture as ossification proceeds. The modern opera- 
tions for congenital bony defects, as fissure of the 
palate, shows how plastic are these palatal and al- 
veolar structures in early infancy. The normal 
oral cavity in infancy is extremely shallow. The 
alveolar ridges are low, and do not approximate 
when the mouth is closed, in which position the 
tongue fills the entire fossa, pressing lightly against 
the fiat, low-vaulted palate. 

The mother's nipple, conical in shape, with proxi- 
mal base, very compressible, is seized in the act of 
nursing by the infant's lips, which are exceedmgly 
prehensible in their function, the anterior alveolar 
ridges being employed to assist the suction in strip- 
ping the nipple from base to apex. The milk, which 
flows freely from the sympathetic breast in response 
to the nervous mechanism of the mother, is thus 
easily secured with but little effort on the part of 
the child, in the line of vacuum formation. To be 
sure, where the flow is meagre or refractory, the 
vacuum-forming apparatus with its sucking pads 
is complete, and may be employed with great energy. 
In all of this, however, the roof of the mouth is dis- 
turbed by little or no pressure, and the child, grati- 
fied with the steady flow of delicious aliment, finds 
but little need for suction sufficient to cause great 
lateral pressure on the alveolar ridges. Moreover 



1 98 CARE OF CHILDREN 

the act of nursing occupies but a short time, and is 
followed by hours of rest. 

The "soother" resembles the maternal nipple 
in no respect. Almost without exception it is pear- 
shaped, the narrow nfeck emerging from a disc of 
bone, which, resting against the outside of the flat- 
tened lips, prevents the apparatus from being swal- 
lowed. This pressure does- away with the prehensile 
function of the lips. The large foreign body, en- 
gaged between the tongue and the yielding, plastic 
roof of the mouth, is mumbled continuously, while 
frantic efforts at suction to derive milk from this 
barren apparatus develop the mechanism for vacuum 
formation to the highest degree. What follows? 
The powerful buccal muscles with their sucking 
pads are continuously forced against the lateral 
alveolar ridges. The upward pressure of this pear- 
shaped body increases the concavity of the yielding 
palatal arch, thus favoring the approximation of 
the superior lateral alveolar ridges. The inferior 
nasal meati, whose floor is thus uplifted, are dimin- 
ished in height. The septum nari, buckling under 
pressure, still further limits the respiratory area of 
the nose. Moreover, the use of the "soother" be- 
comes practically continuous as the habit develops, 
so that the mumbling and sucking continues even 
during the broken slumber. Indeed, it is usually 
interrupted only long enough for the infant to 
receive food, and the infernal contrivance to receive 



THE SOOTHER 199 

fresh smears of bacteria from the never-faiUng 
environmental supply. It is doubtful if this pro- 
lific agent of infection and deformity will ever be 
entirely abolished without legislation prohibiting 
its manufacture and sale. 
1485 Jackson Boul , Chicago 



SUPPLEMENTAL PROGRAM ARRANGED FOR 
CLASSES ON 

CARE OF CHILDREN 

MEETING I 

(Study pages 1-31) 
Before Baby Comes. 

Care of the Child in Health, Oppenheim, pages 1-46. 

($ I. 25, postage I2C.) 
Century Book for Mothers, Yale and Pollock, pages 1-24. 

($2. 00, postage i8c.) 
Care of the Baby, Grififith, pages 17-34. ($1.50, postage 
i8c.) 
The New Born Baby and His Care. 

Care of the Baby, pages 34-46; Century Book for Mothers, 
pages 25-29. 
Clothing. 

Century Book for Mothers, pages 44-58. 
Care of the Baby, pages 86-115. 
Exhibit. 

(i) Make pattern, cut and finish a " baby bag," as shown 
on page 23. Contrast this with a typical pinning 
blanket. 

(2) Show simple and tasteful baby's dresses and over 
elaborate dresses. 

(3) Trace the outline of a child's bare foot. 

(4) Show good and bad shoes. 

MEETING II 

(Study pages 32-53) 
The Nursery, Sleep, Bathing. 

Care of the Baby, pages 213-224, 68-85. 
Century Book for Mothers, pages 18-24. 



202 CARE OF CHILDREN 

See article on The Soother in the Supplement. 
Development and Growth 

Century Book for Mothers, pages 59-76. 

Care of the Baby, pages 46-67. 

If possible, show a weight chart for some baby. 

(Select answers to the Test Questions on Part I and send 

them to the School. Report on supplemental reading, 

etc. for the first two meetings.) 

MEETING III 

(Study pages 55-75) 
Natural Food. 

Food and Dietetics, Hutchison, pages 414-427. ($3.00, 
postage 26c.) 

Care of the Baby, Griffith, pages 1 16-13 2. 

If not familiar with food principles and their use in the 
body, read Food and Dietetics, Norton (Volume VI, 
Library of Home Economics), or send to the Department 
of Agriculture, Washington, D. C, for some of the free 
bulletins called Farmers' Bulletins: No. 142, Principles 
of Nutrition and Nutritive Value of Food; No. 42, 
Facts about Milk; No. 74, Milk as Food; No. 93, Sugar 
as Food; No. 108, Eggs and their Use as Food, etc. 

MEETING IV 

(Study pages 75-122) 
Artificial Feeding 

Care and Feeding of Infants, Holt. (75c. postage 6c.) 

Food and Dietetics, Hutchison, pages 428-453. ($3.00. 
postage 26c.) 

See article in the Supplement on Citrate of Soda m Infant 
Feeding. 

See Farmer's Bulletin, No. 210, The Covered Milk Pail; 
No. 227, Clean Milk. 

Have a report on the local milk supply as to sanitary condi- 
tion of dairies, age of milk when delivered, enforcement 
of local regulations. 



PROGRAM 203 

Visit a model dairy. 

Send for the booklets of the manufacturers of the various 

" infant foods." Weigh the evidence. 
Food for the Second-year and Older Children. 

See Food and Dietetics, Norton (Vol. VI of the Library) 

pages 174-178. 
How to Feed Children, Hogan. ($1.00, postage loc.) 
(Send in answers to the Test Questions on Part II and give 

a report of Meetings III and IV.) 

MEETING V 

(Study pages 123-164.) 
Food Disorders. 

Care and Feeding of Infants, Part III. 

Century Book for Mothers, pages 124-135; 258-265. 
Minor Troubles. 

Send 2 cent stamp to the State Board of Health, Spring- 
field, 111., for their bulletin on "Infant Feeding." 

See article on "Soothing Syrups" in Collier's Weekly, 
April 28, 1906. 

Century Book for Mothers, pages 193-218; 233-242. 
Children's Diseases. 

Care of the Baby, pages 314-336. 

Send to the State Board of Health, Lansing, Michigan, for 
their bulletin on Diphtheria, Scarlet Fever, Whooping 
Cough, Measles, Meningitis, and Teachers' Bulletin No. 
87, " The Milk Problem." 

Also send to the Secretary of your own State Board of 
Health (to the capital city) for any bulletins on conta- 
gious diseases. 

MEETING VI 

■ (Study pages 165-173.) 
Hygiene of the Child and Youth. 

Report on the ventilation, heating, lighting, and sanitary 

care of local schools. 
What attention is given to physical education. 



204 CARE OF CHILDREN 

Read extracts from "The Medical Inspection of Schools," 
Lewis S. Somers, M. D. Prize essay, free from the publish- 
ers. The Maltine Company, Brooklyn, N. Y. (6c. of the 
School.) 

(Send answers to the Text Questions on Part III and give 
a report of Meetings V and VI.) 



INDEX 



Abnormal passages, 134 
Adenoids, 144 
Albumin water, 120 
Anarchistic den, 143 
Artificial feeding, 76-114 
Attention, limit of, 169 
Bab}^ bag, 22 

bottle fed, iii 

care of, 15 

care of before birth, i 

clothes, 20 

needs of, 17 

new bom, 6 
Bacteria in milk, 82 
Bands, 30 
Bare legs, 31 
Bath, bran, 38 

first, 17 

salt, 38 
Baths, duration of, 39 

frequency of, 39 

temperature of, 38 
Bathing, 38, 167 
Beef tea, 119 
Bibliography, 174 
Bones, condition of, 1 1 
Bottle fed baby, 92, iii 
Brain, development of, 168 
Breasts, care of mother's, 4 
Breathing, 12, 124 

deep, 166 
Capacity of stomach, 46 
Care in dressing bab3% 27 

of baby before birth, i 

of mother, i, 70 

of new balDy, 15 

of nose, 144, 166 

of scalp, 19 

of teeth, 165 



Care of throat, 166 

Catarrh, 141 

Certified milk, 86 

Chart, weight, 43 

Chest, development of, 13, 45 

Children at table, 117 

requirements of, 55 
Chicken pox, 156 
Cholera infantum, 133 
Cleansing, first, 15 
Clothes, material of, 2=5 

night, 24 

short, 27 

texture of, 20 

under, 24 

weight of, 20 

winter, 25 
Clothing for older children, 30 
Colds, 141 
Colic, 113, 127 

treatment of, 128 

uric acid, 127 
Colostrum milk, 68 
Composition of milk, 62, 80, 

^ '.°7 . 

Constipation, 40, 128 
Contagious diseases, 153 
Constrictions, dangers from, 

30 
Convulsions, 133 

cause of, 149 

effects of, 152 

symptoms of, 150 

treatment for, 151 
Cord, care of, 16 
Cow's milk. So 
Cows, care of, 83 

selection of, 83 
Croup, kinds of, 145 



205 



2o6 



CARE OF CHILDREN 



Croup treatment for, 146 
Cry, the, 125 
Crying, 37 

persistent, 126 
Daily outing, 37 
Diaper, material of, 26 
Diarrhea, summer, 130 
Dietaries for children, 116 
Digestion, completeness of, 77 

gastric, 76 
Digestive organs, 13 

secretions, development of, 
46 
Diphtheria, cause of, 157 

symptoms of, 157 
Diseases, contagious, 153 

nervotis, 148 

symptoms of, 123 

table of contagious, 162 
Drawers, 28 
Dress of m.other, i 
Dressing, care in, 27 
Drugs, use of, 130 
Earache, 160 
Ear strain, 170 
Education, 167 
Emotion, expression of, 52 
Exercise, 37 
Eye strain. 170 
Eyes, care of, 11, 16 
Fats, 63 
Feeding, 92 • 

artificial, 76-114, 179 

irregular, 59 

substitute, 71 
Fever, 124 

scarlet, 155 
Fevers, eruptive, 153 
Fluids, drain of, 132 
Fontanelles, 10 
Food, artificial, 74 

coarse, 129 

disorders, 113 

first sub-^titute, 73 

for mother, 3 



Food for older children, 115 ■ 

natural, 56 

other than milk, 109 

patent, no 

recipes, 119 

semi-solid, 115 

.test of, 64 

unadvisable, 118 
Foreign bodies, 159 
Formula, making up a, 104 
Formulae, changing, 106 
Fruit juices, 109 
Furnishing of nursery, -^^i 
Games for girls, 168 
Genitals, care of, 39 
Growth, relative, 45 
Gruels, 109 
Head, development of, 45 

shape of, 9 
Health, symptoms in, 123 
Hearing, development of. 51 
Height, table of. 42 
Hot weather diet, 114 
Infant feeding, sodium citrate 
in, 179 

hgyiene, importance of, 6 
Kicking, 37 
Kumyss, 122 
Lactation, period of, 72 
Length, gain in, 44 
Lime water, 120 
Lungs, 12 
Malnutrition, cause of, 139 

treatment for, 139 
Marasmus, 139 
Massage, 129 
Maternity gown, 2 
Materials for children's clothes 

Measles, 153 

German, 154 
Medicine chest, 163 
Meningitis, 160 

Mental attitude of mother, 5, 
66 



INDEX 



207 



Milk, 62, 80 

analysis of, 102 

certified, 86 

changing fats inj 66 

changing proteids in, 67 

colostrum, 68 

composition of, 80 

cow's, 80 

fresh, 89 

home care of, 87 

modified, 82, 90 

mother's, 62 

neutralizing acidity of, 95 

Pasteurizing, 88 

safe, 82 

sterilizing, 88 

unsafe, 88 
Moccasin shoe, 28 
Modified milk, formulae for, 

97 

mixing, 103 
Morning sickness, 3 
Mortality in summer, 131 
Mother, care of, i, 70 

dress of, i 

food for, 3 

mental conditions of, 5 

milk, composition of, 62 
Motor development, 50 
Mutton broth, 119 
Natural food, 56 
Nervous disorders, 148 

system, 14 
Night garment, 24 
Nose, care of, 144 
Nurse, wet, 75 
Nursery, 32 

furnishing of, T)^ 

location of, T)?) 

temperature of, 33 
Nursing, control of, 57 

co-operation in, 60 

early, 56 

effect of frequent, 69 

first, 17 



Nursing, frequency of, 58 

position in, 59 
Nutrition, of the child, 55 
Oil atomizer, 145 
Outing, daily, 37 
Overfeeding, 61, 113 
Passages, abnormal, 134 

normal, 77 
Pasteurizing milk, 88 
Patent baby foods, no 
Peptonized milk, 121 
Protection of baby, 32 
Proteids, 63 

cause indigestion, 81 
Proportions at birth, 9 
Pubescence, 171 
Quality of milk, variation in, 

64 
Quantity of milk, variation in, 

65 
Recipes, 119 

Refrigeration, of milk, 86 
Regularity, 40, 130 
Requirements of child, 55 
Respiration, 12 
Rickets, symptoms of, 137 
Rules for eating, 118 
Scalp, care of, 19 
Scarlet fever, 155 
School hygiene, 171 
Scorbutus, cause of, 140 

treatment for, 141 
Scurvy, 136 

Senses, development of, 50 
Shock, danger of, 18 
Shoes, kinds of, 28 
Short clothes, 27 
Siphoning off milk, 103 
Sitting, 52 
Skin at birth, 6 

care of, 14 
Sleep, 34, 167 
Soap, quality of, 19 
Soidum citrate in infant feed- 
ing, 179 



208 



CARE OF CHILDREN 



Soother, the, 35, 192 
Sore throat, 142 
Spasms, cause of, 149 
Special senses at birth, 15 
Spine, condition at. birth, 11 
Standing, 52 
Starch as food, 109 
Sterilizing milk, 88 
Stimulants, 118 
Stomach, capacity of, 46 
Stools, color of, 135 
Substitute feeding, essentials 

in, 78 
Sucking cushions, 11 

thumb, 36 
Sugar, 63, 10 1 
Summer complaint, 130 

after effects, 134 
Surroundings and care, 2y'^ 
Symptoms in health, 123 
Syringe, use of, 159 
Taste, development of, 50 
Teeth, care of, 39, 165 

examination of, 5 

milk, 47 

order of eruption, 47 

permanent, 48 
Teething, 47 

retarded, 50 
Temperature, 20, 147 

of baths, 38 



Temperature of nursery, 

^} 
variations in, 147 

Thirst, 61 

Throat, care of, 166 

Thumb sucking, 36 

Under clothes, 24 

Unsafe milk, 88 

Uric acid, 62 

Urine, examination of, 4 

Viscous circle, 36 

Vision, development of, 51 

Vomiting, 113, 132 

cause of, 71 
Walking, 52 

Water bath, first general, i! 
Water, importance of, 62 
Weak heart, period of, 169 
Weaning, 71 

early, 72 

time of year, 73 
Weight at birth, 9 

chart, 43 

loss of, 57 

rate of increase in, 43 

table of, 42 
Wet nurse 75 
Whey, 120 
Whining, 126 
Whooping cough, 158 
Winter clothes, 25 



Arh^- \^^^ 



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